While some questions on what NHSE’s imminent abolishment means for integrated care boards (ICBs) – and the pharmacists employed by them – have been addressed by officials, others remain to be answered.
Prime Minister Keir Starmer last week (March 13) made the momentous announcement that the Department of Health and Social Care (DH) is set to absorb NHSE over a two-year period, cutting some 9,300 jobs in total from the bodies.
During a public accounts committee meeting on the same day, NHSE chief financial officer and deputy chief executive Julian Kelly confirmed that the job cuts will also affect ICBs.
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“Sir James Mackey, as the incoming chief executive, has set the target to reduce both the size of NHS England by 50% and has asked ICBs to look at how they can reduce their size by 50%,” Kelly said.
“ICBs currently employ around 25,000 people [so] if you reduce their staff by around 50% you would be achieving around £700-750 million of savings on an annualised basis,” he added.
ICB pharmacists “at risk”?
The decision will see some 12,500 ICB staff losing their jobs.
It has raised questions about how job cuts will affect pharmacists, with Pharmacists' Defence Association (PDA) director Paul Day last week (March 14) telling C+D that “most pharmacists at risk will probably likely be in the 42 ICBs rather than the central and regional NHSE organisation”.
While Kelly told committee members that the cuts will “not apply to the staff who are being employed in hospitals, GP surgeries” and “frontline services”, among those affected are “administrators [and] commissioners”.
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Health and social care committee (HSCC) chair Layla Moran raised concerns over the plans, deeming the 50% job-cut goal an “arbitrary number”.
“We’ve got the 10-year plan coming but not yet published and yet we’ve already decided that 50% is the number,” she said, adding that her “concern is that there are some ICBs who are actually delivering services pretty efficiently”.
It remains unclear whether the government intends to halve the total number of ICB staff across the country, or half the number of staff at each ICB.
Cost cutting
Meanwhile, public accounts committee chair Geoffrey Clifton-Brown raised questions on reports that ICBs will have to cut costs as well as headcounts.
“There’s another important component…the Health Service Journal (HSJ) also says that ICBs are ordered to cut costs by 50%,” he said.
“Now that’s getting much closer to the patient and that seems to me quite an ambitious sort of thing to achieve,” he added.
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Kelly answered that “ICBs already have the totality of the budgets for next year…it is a material impact, but they have the totality of the spend”.
“This will shape, effectively, not the quantum we have shown them but how it is deployed - and the aim really is how do we make sure as much money is going to the frontline services this year, in hospitals, GPs, dentists and so on,” he said.
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He confirmed that while ICBs must halve their “administration costs”, the “budget stays the same” and they must allocate more cash “to the front line”.
But the full scope of potential cuts and what they will mean for pharmacies and pharmacists remains unclear.
And while NHSE told C+D it did not know, the DH has not yet confirmed whether ICBs will take on all commissioning of pharmacy services.
“Financial discipline”
Speaking in the House of Commons on the day of the announcement, health secretary Wes Streeting said that ICB chairs and chief executives had been told to “get an immediate grip on the £5-6 billion deficit that was already being baked in” to the next year’s budget.
“They have become so accustomed to the idea that governments will just come in and bail them out,” he said.
Read more: HSCC give NHSE 2-week deadline for economic analysis update
“We are bringing…financial discipline to the NHS, we will not tolerate deficits,” he added.
Meanwhile, NHSE last month greenlit plans for the “vast majority” of vaccination and screening services to be commissioned locally from April next year.
