ICB Mergers and Clusters: What You Need to Know

ICB Mergers and Clusters: What You Need to Know

The NHS is merging ICBs into ‘ICB clusters’ – does it matter?

To meet the 50 per cent cost reductions required by NHS England and harness economies of scale, the majority of integrated care boards have agreed ‘clustering’ arrangements, with two or more integrated care boards (ICBs) working together across a larger footprint but remaining separate organisations legally.

In other words, each ICB will remain a separate organisation legally with joint leadership across a cluster. Eh? In what way will they exist?

[“We don’t know. And yes, this is a very strange arrangement!” Ed]

Anyway. Current clustering arrangements will not automatically become the new boundaries for merged ICBs. Any merger or change in ICB boundaries is subject to ministerial approval, but clustered ICBs will be exploring mergers to function on their reduced costs.

Out of the (current) 42 ICBs, 19 clusters have been agreed in the Midlands, London, East of England, South East and South West. The 7 ICBs in the North East and Yorkshire Region (4) and North West Region (3) are being left alone.

I.e. there will be 26 entities (19 ICB clusters, and 7 ICBs) in the ‘new ICB world’ (by 1st April 2027).

The first mergers are set to take effect on 1 April 2026. They will take place in London, East of England and South East regions. Decisions on further ICB mergers will take place in summer 2026 and come into effect on 1 April 2027.

New NHS ICB Clusters (and ICBs being left alone), within 7 NHS Regions

1. NHS Midlands (now 5 entities) – 11 ICBs are being merged into 5 clusters

• Leicester, Leicestershire and Rutland with Northamptonshire
• Derbyshire, with Nottinghamshire and Lincolnshire
• Birmingham and Solihull with Black Country
• Staffordshire and Stoke-on-Trent with Shropshire, Telford and Wrekin
• Coventry and Warwickshire, with Herefordshire and Worcestershire.

2. NHS London (4) – of 5 ICBs, 2 ICBs (North-West and North-Central) are merging into one cluster (North West), and 3 left alone – forming 4

• North East London
• North West London
• South East London
• South West London.

3. NHS East of England (3) – 6 ICBs are being merged into 3 clusters

• Central East
• Essex
• Norfolk and Suffolk.

4. NHS South East (4) – 5 ICBs are being merged into 3, and 1 left alone – forming 4 

• Surrey and Sussex
• Thames Valley
• Buckinghamshire, Oxfordshire and Berkshire
• Kent and Medway.

5. NHS South West (3) – 7 ICBs are being merged into 3 clusters

• Cornwall and the Isles of Scilly with Devon
• Gloucestershire with Bristol, North Somerset and South Gloucestershire
• Dorset with Somerset and Bath, North East Somerset, Swindon and Wiltshire.

6. NHS North East and Yorkshire (4) – 4 ICBs being left alone

• Humber and North Yorkshire ICB
• North East and North Cumbria ICB
• South Yorkshire ICB
• West Yorkshire ICB.

7. NHS North West (3) – 3 ICBs being left alone

• Cheshire and Merseyside ICB
• Greater Manchester ICB
• Lancashire and South Cumbria ICB.

Why is all this happening?

Mm. We at MyHSN are not sure. It is probably trying to achieve 2 things:

1. Reduce costs (mainly by 50% staff reductions)
2. Rationalise ICBs geographically. They are currently illogical with very variable size (3-11 per region). In the ‘new ICB world’ there will be 3-5 per region – more logical and fair.

Does all of this matter to the average UK citizen?

No. They will probably see it as further waste of public money by (yet another!) NHS re-organisation. And most of the ‘sacked’ employees will re-emerge somewhere in the new NHS administration system.

[“Pass my deckchair”. Titanic. Ed]

And what will happen to NHS Regions?

Again, we are not sure. We think they will continue as entities for the 26 ‘new’ ICB clusters/ICBs, to work within.