The Legal and Practical Implications of NHS England's Abolition for ICBs
- Admin
- Mar 17
- 3 min read
By Sunil Abeyewickreme
The recent announcement by Prime Minister Keir Starmer to abolish NHS England marks a seismic shift in the governance and management of the National Health Service (NHS). This decision, aimed at reducing bureaucracy and bringing the NHS under direct governmental control, will have profound implications for Integrated Care Boards (ICBs), which are pivotal to delivering health services locally. As a lawyer analysing this restructuring, I will outline the potential legal and operational effects on ICBs.
ICBs' Current Role and Legal Framework
Integrated Care Boards were established under the Health and Care Act 2022 as statutory bodies responsible for commissioning healthcare services within their respective Integrated Care Systems (ICSs). They are accountable to NHS England for financial management, performance, and adherence to national priorities. Their governance structure includes representatives from local authorities, NHS providers, and primary care networks.
With NHS England's abolition, its oversight functions will likely be absorbed by the Department of Health and Social Care (DHSC). This raises critical questions about how ICBs will operate within a restructured framework.
Key Impacts on ICBs
Accountability and Oversight: The abolition of NHS England removes the body that currently holds ICBs accountable. Under the new structure, the DHSC will assume this role. However, this transition could create legal uncertainty regarding enforcement mechanisms. For example, NHS England's powers to direct ICBs under the NHS Act 2006 may need to be reassigned or redefined through legislative amendments.
Budget Cuts and Mergers: The government has mandated a 50% reduction in ICB running costs by December 2025. This will lead to mergers and significant downsizing of leadership roles within ICBs. From a legal perspective, these changes could disrupt existing contracts with healthcare providers and staff, potentially leading to disputes or litigation over redundancy terms and service continuity.
Operational Disruption: The restructuring is expected to stall ongoing projects such as procurement reform and collaboration initiatives. For instance, existing agreements between ICBs and local authorities under Section 75 of the NHS Act 2006 may need renegotiation if governance structures change significantly.
Shift in Autonomy: While the government has framed these changes as decentralizing power to local systems, the centralization of oversight within DHSC may paradoxically reduce ICB autonomy. This could result in increased ministerial intervention in local decision-making, raising concerns about political influence over healthcare delivery.
Legal Uncertainty During Transition: The two-year transition period for abolishing NHS England leaves a legal vacuum for ICBs. Questions remain about how statutory duties—such as reducing health inequalities and improving service quality—will be monitored during this time. Additionally, any failure by ICBs to meet their obligations could lead to enforcement challenges without clear regulatory oversight.
Future Considerations
For ICBs to navigate this period effectively:
Legislative Clarity: The government must amend existing laws to clearly define DHSC's role in overseeing ICBs post-NHS England.
Contractual Protections: ICBs should review contracts with providers to mitigate risks arising from budget cuts or mergers.
Stakeholder Engagement: Collaboration with unions, local authorities, and healthcare providers will be crucial to ensure service continuity amid restructuring.
While these reforms aim to streamline operations and reduce bureaucracy, they risk destabilising local healthcare delivery if not managed carefully. As we await further details on the legislative framework underpinning these changes, it is clear that ICBs stand at a crossroads—facing both challenges and opportunities in shaping the future of healthcare in England.
Sunil Abeyewickreme is a Partner at gunnercooke llp, specialising in healthcare law. He has extensive experience in advising on NHS regulations and contracts, particularly in dentistry and NHS commissioning.
