Source · Select Committees · Public Accounts Committee
Recommendation 6
6
Acknowledged
Require Department to confirm no unfunded commitments and assess costs of structural changes.
Conclusion
We are concerned that the Department for Health and Social Care and NHS England are still announcing major reforms without either delivery plans or secured funding. We do not accept that it is prudent to make a major change, such as the structural changes that are being made to Integrated Care Boards (ICBs) and NHS England without ensuring there is funding in place to pay for the changes, and without conducting an impact assessment or taking other steps to safeguard value for money. These changes, especially the planned cuts to ICBs, could have a significant negative impact on patients and on the healthcare workforce through the level of uncertainty they create, and because they may limit the ability of NHS organisations to plan for the future. We are concerned that these poor practices, previously seen with the New Hospitals Programme and the High Speed 2 programme are being replicated here and will lead to wasted effort. recommendation The Department should • confirm to us that it will not announce unfunded commitments; • set out the likely costs, with associated funding, together with an impact assessment, for the ICB redundancies and the absorption of NHS England; and • set out how organisational changes at local level relate to, and are properly linked with, other partner organisations such as local authorities. 5 1 Progress in reducing waiting lists for elective care Introduction
Government Response Summary
The government agrees, stating ICBs are designing new staffing structures within existing budgets and discussing strengthened Health and Wellbeing Boards' coordination with local authorities, but it does not confirm it will not announce unfunded commitments or provide the requested costs, funding, and impact assessment for ICB redundancies and the absorption of NHS England.
Government Response
Acknowledged
HM Government
Acknowledged
The government agrees with the Committee’s recommendation. Recommendation implemented ICBs are designing their new staffing structures – within the £19 per weighted head of population served – so that they can deliver the ambitions of the 10 Year Health Plan. Central to the Plan is a neighbourhood health service. Local neighbourhoods, where care will be delivered around individuals, will come together under the strengthened Health and Wellbeing Board co-ordinating the different parties necessary to the improvement of the health and wellbeing of the local population, including the upper tier local authority itself and the ICB as the commissioners. As local government reform progresses, there may be more beneficial consistency in the scale of Health and Wellbeing Board footprints as the whole of England moves towards having unitary/metropolitan borough authorities. While there is currently uncertainty on future local government footprints in some part of the country, ICBs understand that they must have the future flexibility to operate effectively with local partners to deliver neighbourhood health together. The department’s letter to the Committee of 11 December 2025, providing further answers to the evidence session of 20 November 2025, addresses how the possible future delegation of ICB functions to local partners is being managed.