The NHS is undergoing its most significant structural change in years. By Q3 2025/26, the 42 Integrated Care Boards across England will operate as just 26 clusters, with many moving toward full mergers by April 2026.
For Trust leaders, this represents far more than administrative reshuffling – it's a fundamental shift that will reshape commissioning relationships, workforce planning, and operational priorities.
For Trust leaders, this represents far more than administrative reshuffling – it's a fundamental shift that will reshape commissioning relationships, workforce planning, and operational priorities.
The Scale of Change
In March 2025, NHS England announced that integrated care boards (ICBs) should reduce their running and programme costs by 50 per cent to become more efficient and reduce duplication, by December 2025. The financial reality is clear: ICBs must reduce their administrative costs by approximately 50%, spending no more than £18.76 per head of the ICS's population by Q3 2025/26.
Across the 42 ICBs, 15 clusters have been agreed and 11 ICBs are not clustering, with the remainder continuing as standalone entities primarily in the North East, Yorkshire, and North West regions.
What Clustering Actually Means
The term "clustering" can be misleading. While ICBs remain separate legal entities during this phase, the practical reality involves shared leadership, combined teams, and unified strategic approaches.
For Trusts, this creates both opportunities and challenges. Larger commissioning footprints mean potentially more coherent strategic direction and resource allocation. But they also mean your Trust may need to engage with new leadership structures and navigate different priorities across merged territories.
The Workforce Challenge Multiplier
The clustering process intersects with the NHS's most pressing operational challenge: workforce shortages. According to the NHS Long Term Workforce Plan, the NHS directly employs 1.7 million people, with projected demand for staff by 2036/37 in the region of 2.3-2.4 million.
Now, as ICBs restructure with efficiency savings of 30% demanded by NHS England, the administrative capacity to support workforce planning and commissioning is simultaneously being reduced.
This creates a compound effect. ICBs are losing experienced commissioning staff just as they need to manage more complex relationships across larger footprints.
Preparing for the New System
The transition creates both immediate and medium-term planning requirements for Trusts. In the immediate term, understanding your new ICB cluster relationships and their leadership structures is essential.
Medium-term, the fundamental challenge is clear: ICBs will focus on strategic commissioning with reduced administrative capacity, while Trusts face the same workforce pressures that require day-to-day operational solutions.
This creates an opportunity for Trusts to build more direct, technology-enabled approaches to workforce management. Forward-thinking Trusts are already exploring alternative models including collaborative platforms that streamline access to qualified healthcare professionals without traditional agency intermediaries.
Building Resilience in Transition
The ICB clustering process will continue through 2025 and into 2026, creating ongoing uncertainty about commissioning relationships and support structures.
For Trust leaders, building organisational resilience during this transition requires focusing on what you can control rather than waiting for external clarity. This includes developing more direct professional networks through collaborative staff banks, investing in employee value propositions that reduce reliance on external recruitment, and building internal capacity for workforce planning.
The Road Ahead
The ICB clustering represents a significant shift in how the NHS organises itself strategically. For Trusts, success in this new system requires understanding that the traditional relationships and support structures are changing fundamentally.
Rather than simply adapting to new ICB structures, the most successful Trusts will use this transition as an opportunity to build more resilient, self-reliant approaches to workforce management.
