NHS England’s Model ICB Blueprint is a significant signal of change, formally shifting ICBs towards a focus on strategic commissioning, while delegating many of their functions to providers, collaboratives, and neighbourhood teams.
At Akeso, we welcome the ambition behind this shift: a model that promotes prevention, integration, and care closer to home. These are the right goals, but structure alone won’t deliver them.
From our work across national bodies, systems, and providers, we know that meaningful transformation depends on more than functional realignment. Here’s where we believe further focus is needed:
1. Governance and Accountability at Neighbourhood Level
The future model hinges on neighbourhoods becoming the engine of delivery. Yet it remains unclear:
- Who holds decision-making authority?
- How will neighbourhoods interface with Trusts, ICBs, and regions?
- What governance, escalation, and assurance mechanisms will underpin this?
National guidance must define these structures, while still allowing space for local adaptation.
2. Local Leadership and Capability
Neighbourhood teams will be expected to lead complex, integrated delivery, across primary care, community services, mental health, and the VCSE sector.
But not all providers are equally positioned to take on this leadership role. GPs, while central to neighbourhood models, are often too subscale or fragmented to lead whole-system delivery. Acute Trusts bring strength in scale but may lack deep experience in neighbourhood-based services.
Community and Mental Health Trusts, however, often sit at the right intersection: they operate at scale, have long-standing local relationships, and work across organisational and sector boundaries. These providers could play a critical leadership role — if equipped with the right governance, data, and digital tools to support coordination, accountability, and trust-building.
3. A Coherent Digital and Data Strategy
Shifting digital oversight to providers brings innovation closer to care delivery, but also risks fragmentation if not managed carefully.
There is an urgent need for:
- National interoperability standards and guardrails
- Clarity on accountability for digital architecture
- Sustained investment in digital infrastructure, analytics, and cyber security
Without this, systems risk duplicative effort, widened inequalities, and slower progress.
4. Integration Beyond the NHS
The blueprint remains largely silent on the role of local government and social care, despite the central role civic partners must play in neighbourhood models.
Neighbourhoods will not succeed if developed solely through an NHS lens. Effective governance must include local authorities, housing, and community assets as equal partners.
5. Transitional Clarity and Implementation Risk
With ICBs expected to submit delivery plans imminently, there is still no clear roadmap for transition.
What’s needed is:
- A staged implementation plan
- Clarity on interim roles and responsibilities
- Mechanisms to safeguard service continuity and accountability
Without this, transitions risk becoming disruptive rather than transformative.
Still to Come: The 10-Year Plan
The blueprint is an important step, but not the full picture. The forthcoming 10-Year NHS Plan will be critical to define:
- How national, regional, and local tiers will interact
- What success looks like for neighbourhood delivery
- Where investment will flow to support transformation
What’s emerging appears to favour a more bottom-up model, one that may evolve toward smaller, leaner ICBs and provider-led neighbourhood systems. But success depends on how systems interpret, govern, and support this shift.
Our View
We support the direction: a system built on prevention, local leadership, and joined-up delivery.
But real transformation demands more than redistribution of responsibility. It requires a coordinated and supported approach, underpinned by clear governance, strong civic partnerships, interoperable digital tools, and sustained investment in neighbourhood capability.
At Akeso, we’re working with systems to turn this ambition into action, co-designing practical delivery models that improve outcomes, reduce inequalities, and make integration real.
The destination has been partially set. What we now need is the map, the resources, and a shared commitment to travelling well.
