New territory for ICB leaders: what to expect and how to prepare

 

The upcoming ICB mergers are creating new territory for leaders who are being asked to manage restructuring, system-level change and public messaging at a scale not seen before in the commissioning landscape. Decisions that would normally take years of planning in other sectors are being made within months, often without precedent or detailed national guidance.

 

The next three months will define how well these new systems are able to operate, collaborate and communicate with their communities. Based on conversations across the sector and our work within the NHS, here are eight areas that leaders should be preparing for as mergers progress.

 

1. The shift in decision making will be gradual

Government has adopted a phased approach to clustering and merging. Some clusters will not formally combine until April 2027, dependent on policy stability. Delays on clarity around redundancies and funding have already disrupted preparations for April 2026 mergers. Combined with the evolving relationship between NHSE and DHSC, leaders should expect reforms to move more slowly than headlines may suggest.

 

2. Strategic ambition may not translate into operational delivery

The ambition to reduce administrative overheads and streamline structures is clear. The path for how ICBs can continue to act as strategic commissioners with significantly reduced budgets has not been fully articulated. Restructuring and reorganisation will take time and will compete for attention with existing strategic priorities. This risk should be acknowledged and prepared for at system, place and programme levels.

 

3. Public perception can be influenced through clear communication

Public awareness of what ICBs do was limited before the restructuring announcements. Without clear communication, the space may be filled by speculation or negative framing. Leaders should expect more questions from patients, residents and elected representatives. Proactive communication across staff, partners and communities can help mitigate confusion and reduce reputational risk during transition.

 

4. The hidden costs of mergers are often underestimated

Headlines tend to focus on redundancy costs and formal process administration. The less visible costs are often felt later. These include retraining, dual running of systems, upskilling new teams, onboarding new leadership structures and temporary inefficiencies during the transition. Many of these costs are difficult to avoid but can be reduced with interoperable digital foundations that allow organisations to integrate rather than replace.

 

5. Loss of institutional knowledge requires structured mitigation

Restructuring processes are already underway and some institutional knowledge will inevitably be lost. In commissioning environments, this knowledge often sits with long-tenured staff or within informal networks. Leaders should consider how essential operational knowledge, archived decisions, stakeholder relationships and local intelligence will be captured, stored and shared in ways that can be accessed across a merged footprint.

 

6. Variation in maturity across footprints will need active support

Different ICBs are entering this phase with differing levels of system maturity and digital capability. Variation is particularly pronounced across digital leadership, digital estates and workforce engagement. National support may not arrive at pace. It may therefore fall to more mature systems to share leadership capacity, model approaches and support partners across the cluster.

 

7. Reducing duplication must not erase local identity

Reducing duplication is one of the core rationales for restructuring. The challenge is to achieve economies of scale without creating distance from communities and place-based partnerships. Multi-tier governance structures are emerging as a credible mechanism to protect local identity, safeguard local voice and maintain accountability. Digital experiences that can reflect both system and place provide useful optionality for future footprints.

 

8. Workforce morale is at risk and requires intentional management

Uncertainty around redundancies, future structures and new priorities is having a tangible impact on morale. Even staff who are not formally at risk face anxiety around their future roles and responsibilities. Leaders who communicate regularly, involve staff in transition planning and provide recognition for effort during change are more likely to retain talent and sustain operational continuity during merger phases.

 

Preparing for the next phase

The year ahead will be one of the most significant periods of organisational change for the commissioning landscape. The speed, scale and political attention surrounding the mergers make preparation essential across four dimensions:

• Workforce and culture
• Digital and information governance
• Public and stakeholder communication
• Operational continuity and strategic delivery
   

Each dimension will require sustained focus as clusters move towards their 2026 and 2027 milestones.

If you would like to discuss digital readiness for mergers further please book in a short exploratory call with Tom Herbert-Maynard.  

---

Join our ICB mergers panel

 

At VerseOne, we believe that collaboration, shared learning and sector-specific discussion are essential for a successful transition. We are hosting a panel discussion focused on the next six months for ICB's. The session will explore:

• What leaders are doing to prepare for merger milestones
• How clusters are managing workforce and morale
• How digital infrastructure can support continuity and scale
• Practical steps for communication and stakeholder engagement
   

If you would like to participate or attend, we would like to hear from you.

Register your interest for the panel

If you would prefer to discuss the ICB Leadership Advisory Board, you can request a short exploratory call with our leading expert, Tom Herbert-Maynard.