Integrated care systems in England: where next?

Local system leaders on the evolving role of ICSs and policy changes needed

The Labour government’s plans for the health service centre on achieving three broad shifts: more community-based care, prevention and use of digital technology. They also involve another round of NHS restructuring, including major changes to ICSs – the area-based agencies responsible for planning and coordinating services.

Drawing on research conducted throughout 2025, our report provides detailed insights into local leaders’ views as the national policy context rapidly evolved around them. Overall, leaders in our research supported the broad goals of Labour’s reforms – including the shift from hospital to community – but had varied interpretations of what they meant in practice and major concerns about delivery. Policy changes introduced throughout 2025, including scrapping NHS England, cutting ICB budgets, merging ICBs across larger geographical areas and redefining the role of ICSs, were also causing widespread disruption and distracting ICS leaders from delivering on the government’s three shifts. 

Standing back, reforms to ICSs should not undermine the cross-sector collaboration needed to tackle the major health challenges facing the nation. Better planning and communication of the government’s reforms are now needed to avoid further disruption and distraction at local level. Policymakers will also need to actively construct the ‘strategic commissioners’ that they want ICBs to become – developing skills and capabilities within local systems and backing them with broader policy changes that make the ambition to shift resources out of hospital a reality.