Classification: Official
Publication reference: PRN01434
To:
- Integrated care board:
- chief executives
- chairs
- NHS England regional directors
- NHS England regional directors of commissioning
cc.
- NHS trust and foundation trust chief executives
Dear colleague,
NHS commissioning: plans to April 2026
Firstly, thank you for the partnership working between integrated care boards (ICBs) and NHS England to strengthen commissioning since ICBs were established in July 2022.
This letter sets out our intention to delegate additional NHS England commissioning functions to ICBs. We remain committed to giving ICBs responsibility for a broader range of functions, enabling them to design services and pathways of care that better meet local priorities, integrate services and improve health outcomes for local populations.
Delegations to date
Between July 2022 and April 2023, we delegated responsibility for pharmacy, optometry and dental (POD) services to ICBs and, in July 2023, we completed transfers of associated commissioning, complaints and some support staff to ICBs.
Delegation of the commissioning of 59 ‘suitable and ready’ specialised services to ICBs took place in April 2024 in three regions (the North West, Midlands and East of England), with NHS England staff in those regions continuing to support delegated services on behalf of ICBs.
Further delegations of direct commissioning functions and proposed staff transfers
We have now reviewed our plans for delegation of specialised services commissioning, and vaccinations, screening and child health information services (CHIS) commissioning, and the proposed staff transfers related to these delegations.
We will ensure that all affected staff are kept informed throughout the proposed changes. Colleagues and Trade Unions will be invited to take part in a consultation process on proposed staff transfers in line with our NHS England Organisational Change policy and legal requirements.
We will work closely with ICBs to prepare for safe and effective delegations of commissioning functions and proposed staff transfers.
Responsibility for the management of complaints about delegated commissioning functions will transfer from NHS England to ICBs when delegation is complete.
- Specialised commissioning
As agreed by our Board in December 2023, we will complete specialised commissioning delegation in April 2025, delegating the final set of specialised services (the 59 services already delegated in three regions, plus 11 other services) in all seven regions. We will consult with staff and Trade Union colleagues on the proposed staff transfers to ICBs, which are also planned for April 2025.
Delegation agreements for specialised commissioning will be put in place with each ICB, making individual ICBs legally responsible for commissioning of delegated specialised services. Staff supporting the commissioning of delegated services will be transferred to one ICB host per region, subject to consultation. They will support the responsibilities of all ICBs in that geography.
NHS England will retain responsibility for commissioning a number of specialised services which were not suitable and/or ready for delegation, including all highly specialised services. Through its commissioning of these services, NHS England will maintain close links with ICBs to ensure that pathways are integrated, insight and intelligence is shared and to minimise additional burden for providers.
- Vaccinations, screening and child health information services (CHIS)
Building on existing partnerships, there will be closer collaborative working between NHS England and ICBs on the commissioning of vaccination, screening and CHIS from April 2025. Responsibility for commissioning vaccination services and suitable elements of screening pathways and CHIS will be delegated to ICBs in April 2026, subject to governance and Secretary of State approval.
The timescale for proposed vaccination and screening delegation has been extended to April 2026 to support a wider review of NHS England’s approach to screening services.
We will consult with colleagues and Trade Unions on the proposed staff transfers to ICBs, which are also planned for April 2026.
As we did for specialised commissioning, NHS England will work closely with ICBs and other stakeholders to determine the suitability of services and functions for delegation in 2026 and the most effective commissioning footprints, and to ensure readiness for the changes.
Other direct commissioning functions
At this stage there are no planned delegations of the commissioning of health and justice or sexual assault and abuse service (SAAS) functions. Commissioning responsibility for these will remain with NHS England, together with healthcare for serving members of the Armed Forces and their families registered with defence medical services, veterans’ mental health and prosthetic services. Alongside those elements of specialised services, screening and CHIS commissioning that are not delegated, they will form a coherent package of retained functions which NHS England will continue to develop.
Oversight and assurance of commissioning
Comprehensive arrangements for the oversight and assurance by NHS England of all commissioning (delegated and retained functions) will be developed and implemented ready for April 2025. These will be complementary to the new NHS Oversight and Assessment Framework.
We welcome your continued input to developing and implementing our plans for NHS commissioning in pursuit of the ‘triple aim’ of better health for everyone, better care for all patients, and efficient use of NHS resources, both for local systems and for the wider NHS.
Yours sincerely,
Steve Russell, Chief Delivery Officer and National Director for Vaccinations and Screening, NHS England
Julian Kelly, Chief Financial Officer, NHS England