Recommendations & Conclusions
23 items
2
Recommendation
79th Report - Supporting people with fr…
Not Addressed
NHS England is not reducing the unacceptable variation in support for people with frailty across and within Integrated Care Boards (ICBs). There is significant and unexplained regional variation between areas – 32 out of 106 local NHS areas assessed less than 10% of patients aged 65 and over. The NICE’s …
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NHS England is not reducing the unacceptable variation in support for people with frailty across and within Integrated Care Boards (ICBs). There is significant and unexplained regional variation between areas – 32 out of 106 local NHS areas assessed less than 10% of patients aged 65 and over. The NICE’s guidelines specify that any patient living with frailty who has fallen in the past year should be offered a comprehensive falls risk assessment and comprehensive falls management. However, in 2024–25, only 30% of local NHS areas could have followed NICE guidelines. NHSE acknowledges that there is variation and told the Committee that it is asking ICBs, particularly those who stand out as poorly performing or with low numbers of people assessed and supported, to tackle this under-performance. recommendation NHS England should seek to reduce variation in support for people with frailty by establishing a threshold for intervening in areas of poor performance. Alongside its response to this report, it should write to the Committee to set out the nature of that intervention. 2
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Government response AI summary
The government states it agrees with the recommendation but then provides a response entirely focused on net zero, innovation funding, and a Net Zero Innovation Board, which bears no relevance to the committee's specific recommendation about NHS England and frailty.
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HM Treasury
3
Recommendation
79th Report - Supporting people with fr…
Not Addressed
NHS England’s existing oversight arrangements are not improving GPs’ assessment and support of people with frailty. It is not clear exactly who is responsible for improving performance. NHSE considers that ICBs are responsible for commissioning services to meet the needs of their population; and that the service providers must ensure …
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NHS England’s existing oversight arrangements are not improving GPs’ assessment and support of people with frailty. It is not clear exactly who is responsible for improving performance. NHSE considers that ICBs are responsible for commissioning services to meet the needs of their population; and that the service providers must ensure that the services they are commissioned to provide are delivered. We are concerned that this divided system could lead to no-one being responsible. NHSE is aware that this system of accountability is challenging for ICBs given the large numbers of providers in general practice and community services. In the future, NHSE intends to hold ICBs to account for commissioning against the promised modern service framework, and expects there will be data from a national frailty dashboard to support the framework. However, it is still finalising details of how this will work. recommendation The Department of Health & Social Care and NHS England should set out how new accountability arrangements will improve how GPs assess and support people living with, or at risk of, frailty.
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Government response AI summary
The government stated it agreed with the recommendation but then discussed initiatives related to green choices, energy efficiency, and zero-emission vehicles, failing to address how new accountability arrangements would improve GP assessment and support for people with frailty.
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HM Treasury
4
Recommendation
79th Report - Supporting people with fr…
Not Addressed
NHS England has overloaded GPs, who have limited capacity, with new and expanding priorities. NHSE has prioritised improving patients’ access and digital access to general practice. It recognises that pushing to improve one aspect of care inevitably causes consequences to appear elsewhere, in this case, support for people with frailty.NHSE …
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NHS England has overloaded GPs, who have limited capacity, with new and expanding priorities. NHSE has prioritised improving patients’ access and digital access to general practice. It recognises that pushing to improve one aspect of care inevitably causes consequences to appear elsewhere, in this case, support for people with frailty.NHSE is looking at interventions that could be done by other healthcare professionals in primary care. For example, NHSE is looking to step up the clinical service provided by community pharmacists including undertaking medication reviews for people with frailty, rather than being just a dispensing service. If this is to be case, community pharmacists must be properly funded to do this work. The Committee is reporting separately on the New Hospital Programme which makes assumptions about the level of work that will be shifted to primary care and which is heavily dependent on more care being delivered in the community. We expect the Department to demonstrate joined-up thinking on capacity and patient flows for primary, community and acute services. recommendation a. NHS England should set out the basis on which it considers GPs and general practice have the capacity to deliver the full ranges of services and responsibilities expected from them. 3 b. Alongside this, NHS England should write to the Committee with details on what they have done to assess of the expected impact of new and expanding priorities on continuity of care for patients with frailty and for digitally excluded patients with frailty. c. NHS England and the Department of Health & Social Care should also set out how neighbourhood health teams will share responsibilities and balance the load of assessing and supporting people with frailty.
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Government response AI summary
The government stated it agreed with the recommendation but then provided a response detailing cross-government coordination and governance for net zero delivery, failing to address GP capacity, impact assessments for new priorities, or how neighbourhood health teams will share responsibilities for frailty.
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HM Treasury
5
Recommendation
79th Report - Supporting people with fr…
Not Addressed
The frailty policy landscape is confusing and fragmented. NHSE and the Department are planning and developing several frailty specific initiatives, such as a national frailty dashboard, and a Modern Service Framework for frailty and dementia. There are also a number of broader developments which may affect service provision for frailty, …
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The frailty policy landscape is confusing and fragmented. NHSE and the Department are planning and developing several frailty specific initiatives, such as a national frailty dashboard, and a Modern Service Framework for frailty and dementia. There are also a number of broader developments which may affect service provision for frailty, such as neighbourhood health, new funding models for ICBs and a refresh of the Better Care Fund. It is unclear whether or how these different initiatives will overlap and interact. It is encouraging that NHSE has commissioned a National Institute for Health and Care Research-led evaluation of frailty pathways and interventions, because it understands that it needs more evidence about which interventions work best. However, it is also concerning that NHSE does not have a clear idea as to whether the range of frailty interventions currently available actually work. recommendation The Department of Health & Social Care should write to the Committee within six months with an update setting out how all frameworks, policy initiatives and dashboards relevant to frailty provision interact and support one another.
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Government response AI summary
The government agreed with the recommendation but provided a response focused on the net zero research and innovation portfolio and a list of past Treasury Minutes, offering no specific commitment to provide an update on frailty policy interaction.
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HM Treasury
6
Recommendation
79th Report - Supporting people with fr…
Not Addressed
We remain deeply concerned that cuts to ICBs are insufficiently thought through and will undermine their ability and capacity to carry out their functions. It is unclear what oversight roles ICBs will retain under NHSE’s plans to make them into strategic commissioners. On 1 April 2025, NHSE announced that ICBs …
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We remain deeply concerned that cuts to ICBs are insufficiently thought through and will undermine their ability and capacity to carry out their functions. It is unclear what oversight roles ICBs will retain under NHSE’s plans to make them into strategic commissioners. On 1 April 2025, NHSE announced that ICBs had to make 50% cost reductions. To achieve this, ICBs are planning large scale redundancies and NHSE will transfer some of ICB’s current functions away from ICBs. The planned reduction in resource across all ICBs risks undermining well-performing ICBs while limiting the ability of poorly-performing ICBs to improve. This is a matter that we expect to return to during the course of this Parliament. 4 recommendation NHS England and the Department of Health and Social Care should set out what further reassurances they can provide to the Committee that ICBs’ cost reductions will not impact on ICBs’ ability and capacity to carry out their functions effectively. 5 1 Support and oversight of support and care for people living with frailty Introduction
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Government response AI summary
The government stated it agrees with the recommendation but then provided a response entirely focused on the net zero research and innovation portfolio, failing to address the committee's concerns about ICB cost reductions or provide reassurances from DHSC and NHSE.
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HM Treasury
1
Conclusion
79th Report - Supporting people with fr…
Not Addressed
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and from NHS England (NHSE).1
Government response AI summary
The government stated it agreed and that the recommendation was implemented, but then provided a response detailing funding for net zero initiatives, which is irrelevant to the committee's statement about taking evidence from DHSC and NHS England.
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HM Treasury
7
Conclusion
79th Report - Supporting people with fr…
Not Addressed
For all patients diagnosed with severe frailty, the GP contract requires GPs to do a clinical review. This includes a review of the patient’s medication, a falls risk assessment and a discussion with the patient of the benefits of having an enriched summary care record that provides healthcare professionals with …
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For all patients diagnosed with severe frailty, the GP contract requires GPs to do a clinical review. This includes a review of the patient’s medication, a falls risk assessment and a discussion with the patient of the benefits of having an enriched summary care record that provides healthcare professionals with access to core details about the patient (medications, allergies, bad reactions) plus additional information from GP records to aid care. GPs are not providing the required levels of follow-up support. In 2024–25, 226,000 patients were diagnosed with severe frailty. Of those patients only 16% had a medication review, 18% had a falls risk assessment and 29% had given consent for an enriched summary care record.12 NHSE told us that it did not have a clear idea of how many people had been formally assessed for frailty. It acknowledged that only a small proportion of people who were recorded as being moderately or severely frail, were getting support and that this problem needed addressing.13
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Government response AI summary
The government stated it agreed with the recommendation but then discussed the 'Framework Delivery Plan' and provided a long list of past Treasury Minutes, failing to address the committee's observations on GP frailty assessments and support.
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HM Treasury
8
Conclusion
79th Report - Supporting people with fr…
NHSE pointed to the large proportion of people with severe frailty living in care homes and how it expected primary care networks to provide support such as weekly ward rounds.14 NHSE recognised that this care needed 8 Q 2 9 C&AG’s Report, para 3.2 10 C&AG’s Report, para 3.4 11 …
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NHSE pointed to the large proportion of people with severe frailty living in care homes and how it expected primary care networks to provide support such as weekly ward rounds.14 NHSE recognised that this care needed 8 Q 2 9 C&AG’s Report, para 3.2 10 C&AG’s Report, para 3.4 11 Qq 3-4 12 C&AG’s Report, paras 13 and 3.8; Q 8. 13 Q 3 14 Q 3 8 improving.15 The number of care home residents with a personalised care plan dropped from 76% in 2022–23 to 44% in 2024–25. The percentage of residents who had a medication review fell over the same period from 72% to 45%.16 NHSE argued that while it has assurance that work such as weekly ward rounds are happening, they do not know if GPs are reviewing care plans as GPs may not record this work.17 Variation in support for people with frailty across and within ICBs
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HM Treasury
9
Conclusion
79th Report - Supporting people with fr…
In 2024–25, 32 of 106 local NHS areas (known as sub-ICBs) assessed less than 10% of their registered patients aged 65 or over. However, nine of 106 local areas assessed 90% or more of this group of people, suggesting that good performance is possible within existing resources.18 The National Institute …
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In 2024–25, 32 of 106 local NHS areas (known as sub-ICBs) assessed less than 10% of their registered patients aged 65 or over. However, nine of 106 local areas assessed 90% or more of this group of people, suggesting that good performance is possible within existing resources.18 The National Institute for Health and Care Excellence (NICE) guidelines specify that any patient living with frailty who has fallen in the past year should be offered a comprehensive falls risk assessment and comprehensive falls management. The data indicate that most local areas (70%) are not following NICE guidelines as the number of people who had a falls risk assessment is lower than the number of people who had a fall. There is also significant local variation across local NHS areas in the percentage of care home residents with agreed or reviewed care plans.19
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HM Treasury
10
Conclusion
79th Report - Supporting people with fr…
NHSE acknowledged the scale of variation and that tackling variation was one way it was trying to improve performance overall.20 NHSE told us that the reasons for variation will be different in different places. For example, some areas may have a disproportionately more frail population, may struggle to attract workforce …
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NHSE acknowledged the scale of variation and that tackling variation was one way it was trying to improve performance overall.20 NHSE told us that the reasons for variation will be different in different places. For example, some areas may have a disproportionately more frail population, may struggle to attract workforce or even may not have focused on frailty as a priority in the way that NHSE would want.21 NHSE told us that it is working with ICBs, through regular assurance meetings, on how to identify outliers and address variation, across and in some cases, within an ICB. It noted that it is asking ICBs in areas with negative outliers or particularly low numbers of people being assessed or offered interventions to tackle poor performance.22 15 Q 3 16 C&AG’s Report, para 3.13 and figure 12. 17 Q 25 18 C&AG’s Report, para 3.6 19 Q 10;C&AG’s Report, para 3.13 and figures 12 and 13. 20 Q 11 21 Q 31 22 Qq 3, 11 and 30 9
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HM Treasury
11
Conclusion
79th Report - Supporting people with fr…
NHSE also highlighted variation in terms of the range of community services across the country that are not specified or described clearly or consistently. It explained that these services are coded, measured and counted in different ways and often funded through block contracts. NHSE is seeking to standardise community services …
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NHSE also highlighted variation in terms of the range of community services across the country that are not specified or described clearly or consistently. It explained that these services are coded, measured and counted in different ways and often funded through block contracts. NHSE is seeking to standardise community services which it hopes will enable it to properly identify “true” variation instead of seeing different ways of describing services.23 NHSE reported that it has standardised about 75% of all community services, which it expects will give ICBs the information they need to properly identify local need and commission appropriately to respond to that need.24 Oversight arrangements
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HM Treasury
12
Conclusion
79th Report - Supporting people with fr…
NHSE has set requirements for ICBs and GPs to provide health services that aim to assess and support people living with moderate and severe frailty.25 NHSE considers that ICBs are responsible for managing and measuring performance of many of the services that aim to support people living with frailty.26 NHSE …
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NHSE has set requirements for ICBs and GPs to provide health services that aim to assess and support people living with moderate and severe frailty.25 NHSE considers that ICBs are responsible for managing and measuring performance of many of the services that aim to support people living with frailty.26 NHSE told us that ICBs are responsible for commissioning services to meet the needs of their population but that it is also their responsibility to make sure that commissioned services are happening as contracted. However, there is limited national level data on some frailty related services, and what is available only measures some aspects of performance. This stops NHSE having a good national understanding of the quality of services provided and prevents ICBs benchmarking their performance with others. NHSE also recognised that while providers are responsible for delivering the services “some of this is everybody’s responsibility” and agreed that this introduced the risk that sometimes everybody’s responsibility becomes nobody’s.27 NHSE was aware that this system of accountability is challenging for ICBs given the large numbers of providers in general practice and community services.28
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HM Treasury
13
Conclusion
79th Report - Supporting people with fr…
NHSE told us that it is working to improve accountability and that, in the future, it intends to hold ICBs to account for commissioning against the modern service framework and expects there will be data from its national frailty dashboard to support the framework.29 However, it is still finalising details …
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NHSE told us that it is working to improve accountability and that, in the future, it intends to hold ICBs to account for commissioning against the modern service framework and expects there will be data from its national frailty dashboard to support the framework.29 However, it is still finalising details of how this will work.30 23 Q 11 24 Q 11 25 C&AG’s Report, para 2.8 26 C&AG’s Report, para 2.12 27 Qq 12-13 28 Qq 13-14; C&AG’s report, para 2.13 29 Q 9 30 Qq 7, 9, and 17 10
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HM Treasury
14
Conclusion
79th Report - Supporting people with fr…
NHSE also told us that it was about to write to ICBs, as part of the framework for neighbourhood health, with the key requirements that ICBs need to have in place next year around enabling better, more appropriate care for the moderately and severely frail population. NHSE also agreed that …
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NHSE also told us that it was about to write to ICBs, as part of the framework for neighbourhood health, with the key requirements that ICBs need to have in place next year around enabling better, more appropriate care for the moderately and severely frail population. NHSE also agreed that oversight would be a bigger challenge for ICBs to deliver with 50% fewer staff.31 31 Qq 9 and 17 11 2 NHS landscape for improving frailty services Overloading and limited capacity of GPs
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HM Treasury
15
Conclusion
79th Report - Supporting people with fr…
We were concerned that GPs might not be prioritising care for those with or at risk of frailty. NHSE acknowledged that GPs were not formally assessing enough of their patients for frailty.32 NHSE recognised that it had pushed GP practices very hard over the past couple of years to improve …
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We were concerned that GPs might not be prioritising care for those with or at risk of frailty. NHSE acknowledged that GPs were not formally assessing enough of their patients for frailty.32 NHSE recognised that it had pushed GP practices very hard over the past couple of years to improve access. However, it agreed that since capacity is constrained and demand exceeds capacity, which is true across general practice, pushing to improve one aspect of care inevitably causes consequences to appear elsewhere, in this case, support for people with frailty.33
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HM Treasury
16
Conclusion
79th Report - Supporting people with fr…
NHSE was clear that the “ position we are in is not acceptable”.34 The Chief Medical Officer also explained that to understand GPs’ capacity, it is important to factor in geographic or demographic pressures. These could include rural or peripheral areas that have very large or increasingly large proportions of …
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NHSE was clear that the “ position we are in is not acceptable”.34 The Chief Medical Officer also explained that to understand GPs’ capacity, it is important to factor in geographic or demographic pressures. These could include rural or peripheral areas that have very large or increasingly large proportions of the elderly population, and where it is often more difficult for people to come to their GP because of distances.35
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HM Treasury
17
Conclusion
79th Report - Supporting people with fr…
NHSE told us that it is looking at interventions that could be done by other health care professionals in primary care. For example, enhancing the clinical service community pharmacists provide to include undertaking medication reviews for people with frailty.36 However, we have had written evidence from pharmacists who are keen …
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NHSE told us that it is looking at interventions that could be done by other health care professionals in primary care. For example, enhancing the clinical service community pharmacists provide to include undertaking medication reviews for people with frailty.36 However, we have had written evidence from pharmacists who are keen to do this work but told us that it is not adequately funded.37 32 Q 3 33 Q 6 34 Q 7 35 Q 8 36 Q 45 37 Q 45; Community Pharmacy England (SPF0008) 12 Patchwork nature of initiatives
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HM Treasury
18
Conclusion
79th Report - Supporting people with fr…
NHSE has put in place multiple initiatives that aim to help with frailty. It has set requirements for ICBs and GPs to provide health services that aim to assess and support people living with moderate and severe frailty. They include frailty assessments, healthcare for people in care homes (through the …
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NHSE has put in place multiple initiatives that aim to help with frailty. It has set requirements for ICBs and GPs to provide health services that aim to assess and support people living with moderate and severe frailty. They include frailty assessments, healthcare for people in care homes (through the Enhanced Health in Care Homes programme) and services to provide care in people’s homes and avoid admitting them to hospital such as urgent community response and virtual wards. Local areas deliver and prioritise these services differently and they commission these services based on local need. As a result, there is no consistent national frailty provision.38
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HM Treasury
19
Conclusion
79th Report - Supporting people with fr…
NHSE informed us that it was establishing a national frailty dashboard which will take into account the range of interventions that NHSE expects ICBs to have in place. It noted that it does not intend to publish what it considered to be “experimental data” collected in its first year, 2026–27, …
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NHSE informed us that it was establishing a national frailty dashboard which will take into account the range of interventions that NHSE expects ICBs to have in place. It noted that it does not intend to publish what it considered to be “experimental data” collected in its first year, 2026–27, but will publish the data thereafter.39
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HM Treasury
20
Conclusion
79th Report - Supporting people with fr…
NHSE informed us that there are also a number of broader developments which may affect service provision for frailty including a forthcoming modern service framework, new funding models for ICBs, a frailty improvement collaborative involving seven sites around the country, the commissioning oversight framework and a refresh of the Better …
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NHSE informed us that there are also a number of broader developments which may affect service provision for frailty including a forthcoming modern service framework, new funding models for ICBs, a frailty improvement collaborative involving seven sites around the country, the commissioning oversight framework and a refresh of the Better Care Fund.40 It is unclear when these will be implemented, and whether or how these different initiatives will overlap and interact.41
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HM Treasury
21
Conclusion
79th Report - Supporting people with fr…
NHSE recognised that it needs more evidence to understand which interventions make a difference for patients with frailty and has commissioned a National Institute for Health and Care Research-led evaluation of frailty pathways and interventions.42 Changes to ICBs’ responsibilities
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NHSE recognised that it needs more evidence to understand which interventions make a difference for patients with frailty and has commissioned a National Institute for Health and Care Research-led evaluation of frailty pathways and interventions.42 Changes to ICBs’ responsibilities
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HM Treasury
22
Conclusion
79th Report - Supporting people with fr…
In March 2025, the government announced it would abolish NHS England and change the responsibilities of ICBs.43 In April 2025, NHSE announced that ICBs had to make 50% cost reductions.44 To achieve this, ICBs are planning large scale redundancies and NHSE will transfer some of ICB’s 38 C&AG’s Report, para …
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In March 2025, the government announced it would abolish NHS England and change the responsibilities of ICBs.43 In April 2025, NHSE announced that ICBs had to make 50% cost reductions.44 To achieve this, ICBs are planning large scale redundancies and NHSE will transfer some of ICB’s 38 C&AG’s Report, para 2.8 39 Qq 9 and 11 40 Qq 9, 38-39 and 40-41 41 Qq 40-41 42 Q 9 43 C&AG’s Report, paras 4 and 2.2 44 Qq 17-20 13 current functions.45 NHSE’s Model ICB Blueprint paper outlined the refreshed role of ICBs which would be shifted to “strategic commissioners working to improve population health, reduce inequalities and improve access to more consistently high quality care”.46 The Department told us that as with any programme of transition, it is monitoring ICBs’ statutory responsibilities very tightly.47
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HM Treasury
23
Conclusion
79th Report - Supporting people with fr…
We heard of one element of an ICB that currently has 40 people in place but which will have one person discharging that responsibility from April 2026. We are not convinced that this reorganisation has been thought through properly and resourced adequately, since if ICBs currently do not have the …
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We heard of one element of an ICB that currently has 40 people in place but which will have one person discharging that responsibility from April 2026. We are not convinced that this reorganisation has been thought through properly and resourced adequately, since if ICBs currently do not have the ability or capacity to perform their existing functions, it will be a bigger challenge with 50% fewer staff.48 The planned reduction in resource across all ICBs risks undermining good performing ICBs while limiting the ability of poor performing ICBs to improve.49 NHSE agreed to come back to us with answers to all our questions on ICBs.50 We have heard much that has left us deeply concerned that a 50% reduction in ICB’s workforce will hamper their capacity to carry out both their existing role and any new responsibilities related to frailty. 45 Q 22; Letter from NHS England, 6 November 2025 46 NHS England, Model Integrated Care Board Blueprint 47 Q 22 48 Qq 17-20 49 Qq 17-19 50 Q 23 14
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HM Treasury