What ICB Devolution Means for Integrated Local Health and Care Leadership

Dawn Faulkner looks at the potential impact of ICB devolution on local health and care solutions.

The devolution of Integrated Care Boards (ICBs) marks a significant evolution in how health and care services are planned, commissioned and delivered at local level. While the change reshapes the NHS, its deeper impact is on the relationship between healthcare providers and local authorities. From 2026 onwards, councils move decisively from being supporting partners in health reform to co‑leaders of integrated, place‑based systems focused on population outcomes rather than organisational boundaries.

ICBs are now being refocused as leaner, more strategic bodies. Their role is shifting away from detailed operational oversight towards long‑term stewardship of population health, partnership commissioning and system leadership. As performance management increasingly sits at regional NHS level, delivery responsibility concentrates at ‘place’. This makes the effectiveness of local integration, not national structures, the critical determinant of success.

Integration at Place: From Policy to Practice

However national policy to reduce hospital demand and strengthen community‑based care cannot be met without adult social care, public health, housing and the voluntary and community sector working as a single, coordinated ecosystem. Neighbourhood‑based models of care depend on councils to provide the conditions that support independence and wellbeing. Key place-based services, supported housing, early help, community safety and prevention are now essential components of healthcare.

As a result, local government is becoming a central player in shared governance and place‑based delivery arrangements. Integrated boards and partnership forums increasingly cut across NHS and local government, with councils exerting greater influence over service design and priorities. With that influence comes greater accountability. Outcomes once understood primarily as ‘NHS business’ such as preventing avoidable admissions or addressing health inequalities are now collective responsibilities, judged by what residents experience locally rather than by formal accountability lines.

Greater Local Flexibility, Greater Local Scrutiny

A defining feature of devolution is increased variation between places. With less national prescription and more local discretion, integrated care models will increasingly reflect local need, leadership capacity and partnership maturity. Some systems will move rapidly, innovating around community diagnostics, virtual wards and multidisciplinary neighbourhood teams. Others may progress more slowly, constrained by workforce shortages and fragile social care markets.

For local authorities, this variation brings heightened visibility. Even where accountability is shared, councils are often the most visible democratic institution locally, which intensifies scrutiny when integration fails to deliver.

Capacity Pressures and the Shifting Balance of Responsibility

At the same time, ICBs are operating with significantly reduced running costs. While leaner commissioning structures may streamline decision‑making, they also risk limiting system coordination and strategic capacity. In practice, responsibilities for service redesign, community engagement and pathway integration may shift towards councils and providers, frequently without additional resource.

Where place‑based leadership is strong and partnerships are mature, councils are well positioned to shape priorities and maintain coherence across the system. Where it is weaker, there is a risk that local government absorbs risk and expectation without corresponding control. Effective integration therefore depends as much on governance, relationships and leadership capability as it does on formal structures.

Population Health and Inequalities: Local Government’s Strategic Moment

Population health, prevention and inequality reduction are no longer aspirational objectives, they are explicit performance expectations. ICBs are assessed against social value, prevention outcomes and progress in narrowing entrenched inequalities. National frameworks increasingly focus attention on the most deprived communities and inclusion groups.

These are areas where councils possess the most powerful and direct levers through housing quality, employment and skills, community development, environmental health and local preventative interventions. Devolution strengthens local government’s strategic hand, but it also sharpens expectations.

Implications for Senior Leadership and Talent

These changes fundamentally reshape the leadership landscape across local health and care systems. Councils increasingly need senior leaders who are comfortable working across boundaries and leading through influence rather than hierarchy. Integration demands confidence in complex, partnership‑led environments where resources are constrained, decisions are shared and accountability is diffused.

Strategic commissioning in this context places a premium on analytical capability and systems thinking. Leaders must interpret population data, understand service interdependencies and make transparent trade‑offs between competing priorities. Traditional service management expertise remains important, but on its own it is no longer sufficient.

As a result, the senior talent profile is broadening. Councils are increasingly seeking executives with hybrid careers spanning health, social care, public health or large‑scale transformation. Talent pools may widen to include senior leaders from NHS providers and the voluntary sector who bring strong place‑based delivery experience.

Retention may prove even more challenging than recruitment. Devolved, integrated models increase role complexity, political exposure and public scrutiny. Senior leaders must balance long‑term prevention ambitions against immediate operational pressures, often acting as system problem‑solvers when capacity elsewhere is constrained. Without clear remits, strong partnership machinery and visible political support, the risk of leadership churn rises when stability is most needed.

Making Integration Work

In this landscape, success will depend on how local government invests in the leadership required to make integration real. Councils that design roles around system leadership, support collaboration and create realistic operating conditions will be better placed to attract and retain the talent essential to delivering genuinely integrated health and care for communities.

Dawn Faulkner is Partner at Faerfield Limited. Originally published on Healthcare Management Online, 12 May 2026.

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