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 per cent 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.
ICBs are currently running voluntary redundancy schemes to achieve the steep reductions after months of uncertainty last year, around how the redundancies would be funded.
One ICB leader raised concerns that there was “no plan” behind the ICB restructure – noting, for example, that the Model ICB blueprint in May and Model Region document in September were not designed simultaneously.
They said: “So, it isn’t the pace of change… We could have done big-bang change with a plan… But what we can’t do is constant evolutionary thinking to create a plan on the hoof.”
One community leader said: “The way that they’ve done it, in such a brutal, non-humane way to ICB staff, and then not having enough money for redundancy payments. I mean, it’s just so pathetic.”
The research also flagged major concerns that the cuts were a distraction.
One leader said that “so much instability at every level” was “not exactly the ideal conditions to be implementing major service transformation”.
The Health Foundation interviewed 39 senior leaders from May to November, across ICBs, place teams, providers, councils, and community organisations.
‘Knock-on effects’
Cuts are likely to “have knock-on effects for other parts of the system”, including “the ability to continue funding place-based teams”, leaders told report authors. Local relationships would be “disrupted by various reorganisations”, the report said, particularly in ICBs that are merging.
One leader said the “stress” of the changes could lead people to “revert back into some of the old-school commissioning traditional behaviours”.
Another voiced concern about “pulling back” to the 2000s, when “providers spent all their time trying to get paid more by commissioners”.
One possibility is that providers will take on a bigger role in system leadership – for example, through emerging “integrated health organisations” – but several leaders raised concerns that this would lead to acute hospital dominance and less effective partnership working.
Phoebe Dunn, senior fellow at the Health Foundation and one of the report authors, said: “We’re still not clear what the timeline is for some of these changes, with quite limited guidance or information on the new system or how it will work, what roles, and functions ICBs will be expected to deliver.”
She also told HSJ that a simultaneous local government reorganisation could be an opportunity for the NHS to build stronger relationships. The reforms are due to scrap district councils, merging them into a reorganised single-tier, while strategic authorities and mayors are being introduced more widely.
Ms Dunn added: “But the NHS still needs really close relationships with local authorities. They’re the ones responsible for adult social care, public health, and there’s a risk of losing some of that with the changes, particularly with ICBs merging and covering larger areas.”
Interviewees broadly supported the government’s goals – including strategic commissioning, shifting from hospital to community, and the abolition of NHS England –but “had varied interpretations of what they meant in practice and major concerns about delivering them”, the report concluded.