The Week 9 May 2025
Director of Policy and Research
It’s been quite the week for the UK domestic policy world – though you’d be forgiven for not noticing, since international affairs, foreign wars, and trade deals continue to dominate our attention.
Those interested in the future of our health system, for example, should try to make time to look through a new ‘blueprint’ published this week on the evolving model for Integrated Care Boards. With the main arms-length body of NHS England on its way to a place where no arms (of whatever length) will be able to reach it, questions are being asked about whether this will ultimately lead to a devolution and localisation agenda worthy of the topic (yes please).
Integrated Care Systems’ operational funding was cut at the last Budget and it now seems that this will be a prelude to a significant consolidation of these bodies so that each operates over a larger footprint. With public service coterminosity and Strategic Authority involvement in ICBs both getting a mention in the English Devolution White Paper last year, there is some room for excitement about what could potentially be in store.
This week’s ‘blueprint’ doesn’t quite give us the answers we need, though. It’s quite up-front about the fact that the very tricky work of figuring out the actual responsibilities and roles of the relevant local players has not been done yet, stating early on that we are seeing it “without the corresponding picture of what the future of neighbourhood health will look like or the role of the centre or regional teams.”
So there isn’t a clear sense of ‘how’ to proceed from the Government. But the vision set out in the document is, at least, welcome, and may feel familiar to those following the output from our Reimagining Health programme. At its heart is a shift from an effective oversight role to one where ICBs are in the trenches of strategic commissioning, with the aim of diverting more resources out of acute services in the long-term.
Strikingly, given this is a document about a regionalised system for the NHS, there’s very little direct discussion of local government or the role it should play. Strategic or Combined Authorities, and the Mayors that lead them, get no mention here at all. Local government as a whole gets sidelined into a single paragraph. There’s still scope to correct this, but the overall sense is of an ambitious vision that is blinkered into the assumption of traditional, ‘internal’, oversight of health sevices by health services.
Time will tell whether the current appetite for radical change will extend to a version of the ICS system that actually integrates with other local public services to deliver better services.
Read of the week...
Sticking with our Reimagining Health theme, this week I’d recommend taking a look at the terms of reference that have just been published for the Casey Commission on adult social care. Whether or not you endorse the view that another big multi-year review is the right move given the self-evident unsustainability of the current model (can you guess what I think?), there’s little doubt that this review, and its conclusions, will become the most important reference point for any eventual attempt to fix the system. These TORs give a sense of a reform programme extending as far as 2036, but also one that is at least going to be mindful of the real constraints to the system: compatibility with wider health system objectives, and the overall fiscal constraints affecting the system.
I’ll leave you with one cause for hope, and one for scepticism, both arising from the same document. The hopeful hint here is that the Commission is, very sensibly, going to disentangle the care of older people from the care of working-age adults. The worrying part is the prevailing sense that the Commission will not be interested in exploring alternative new funding approaches for the system, but rather the optimisation of existing resource streams. It is hard to imagine a transformative plan emerging here without looking at funding policy.