Care Sector Faces Knock-On Effects as Watchdog Warns NHS Restructuring is Straining Council Partnerships
The shrinking of England’s integrated care boards (ICBs) could damage the working relationship between the NHS and local councils, the National Audit Office (NAO) has found, raising questions for social care providers who depend on both.
In a report published this week on the ICB reforms, the spending watchdog said councils had told auditors that experienced ICB staff were leaving. They said this was hampering delivery of programmes and weakening joint commissioning.
NHS England’s own risk register rated the dangers of the new ICB model as “amber-red”, the NAO said. The rating reflected serious concerns raised by local authorities and by the Ministry of Housing, Communities and Local Government.
The number of ICBs and ICB clusters has dropped from 42 to 25 within a year. NHS England is aiming to cut running costs by 43%, which would mean losing roughly 8,000 posts.
Local government specialists told the NAO that bigger ICB areas risk leaving the organisations distant from communities and slower to respond to local need.
The report also questioned how a single ICB covering several council areas will meet its statutory safeguarding duties. These include the requirement for council and ICB chief executives and other local partners to meet every six months.
Councils also described falling NHS financial contributions and disagreements over who pays for what, including uneven application of NHS Continuing Healthcare (CHC) frameworks. The NAO said such problems could add to the financial pressure on local government. For providers, CHC decisions directly affect how residents’ care is funded.
The audit office noted that councils are absorbing many changes simultaneously. ICB restructuring is running alongside local government reorganisation, funding reform, devolution, SEND reform and changes to children’s social care. The NAO cautioned that this mix could leave councils less able to manage change effectively.
The government has pledged to align ICB boundaries with those of strategic authorities by the end of this Parliament. Last month NHS England said further ICB mergers pencilled in for 2027 would be pushed back to 2028 at the earliest, so that the national picture can become clearer.
The NAO acknowledged that closer ICB and council alignment could deliver real gains in efficiency, prevention and community-based care. It urged both sides to protect their relationships through the transition.
Wendy Taylor, a Liberal Democrat councillor who chairs the Local Government Association’s (LGA) health and wellbeing committee, said the two sectors must “reform together, not retreat into silos”. She argued that shrinking ICB capacity threatens the joint working needed to improve public health and reduce inequalities. She also said councils must not be left plugging gaps in coordination, planning and system leadership.
Cllr Taylor called on government to work with councils to review CHC funding. She said more attention was needed on evidence that shifts in eligibility decisions and practice may be moving costs from the NHS to local authorities, and warned against any unfunded transfer of costs.
Ian Perrin of the ICB network, which sits within NHS Alliance, said ICB leaders would welcome the report’s acknowledgement of the disruption caused by reorganisation and the ongoing difficulties of implementing it. He called for clearer roles within the NHS operating model, an end to unnecessary structural change, and investment in ICBs’ strategic commissioning capability.
A spokesperson for DHSC said: “We are grateful for the dedication and hard work of everyone working across integrated care boards, in what has already been an exceptionally busy year.
“Reducing ICB running costs and operating at an effective scale is a necessary part of reforming the NHS so that more funding reaches the frontline. These changes allow ICBs to focus on strategic commissioning and deliver the changes in our 10 Year Health Plan.
“We thank the NAO for their report and their recognition that ICB clustering arrangements and mergers are already enabling benefits to be realised locally.”
