Revealed: ICBs which cut staff by a fifth in 12 months
Several integrated care boards have cut their staffing by up to a fifth in a single year – after being asked to reduce management costs – but significant variation exists, HSJ analysis shows.
ICBs were told last March to reduce their running costs – most of which, though not all, is their staff – by 30 per cent by 2025-26.
Many ICBs started restructuring in 2023, and HSJ analysis of staffing figures shows ICBs had already made deep reductions as of May this year. North Central London, Hampshire and Isle of Wight, Mid and South Essex, and Devon all had between 17 per cent and 20 per cent fewer whole time staff than in May 2023.
However, others have much smaller reductions, and some have even seen large increases.
Despite large swings among the ICBs, total WTE staff across all ICBs remained remarkably static over the year to May, remaining between 22,000 and 23,000 throughout the period.
ICB leaders told HSJ the variation mostly reflected the different situation for each ICB. Some formed in 2022 from a merger of multiple long-standing clinical commissioning groups and have restructured during 2023-24 to combine those inherited teams, whereas other areas had done this earlier.
Others have reorganised their commissioning support services — either in-housing staff, or sometimes moving them to another host organisation; taken on delegated responsibilities; or shifted some functions to provider trusts.
Meanwhile, some ICBs have leaned much more on cutting other costs, such as consolidating premises and removing vacant posts, avoiding the need to reduce headcount.
ICBs’ cuts or growth since last year show little apparent link to how many staff they employ compared to their budget allocation. Instead, those with the highest staff-to-spend ratio are smaller ICBs, such as Gloucestershire, while the largest ICB — the North East and North Cumbria — has the lowest ratio.
Mid and South Essex — which saw an 18 per cent reduction in WTE staff from 545 to 374 — told HSJ around 100 staff left through voluntary resignation, voluntary redundancy and compulsory redundancy in 2023, through an organisational change programme.
HSJ understands North Central London — which saw a 17.1 per cent reduction — cut a significant number of roles in 2023-24 because it wanted to press on early with the restructure required to reduce admin spending.
Devon ICB (20.2 per cent reduction) told HSJ it was implementing a new structure this month, following an all-staff consultation, but has already run a voluntary redundancy scheme; reduced non-pay costs; reduced temporary staffing; and introduced a “vacancy control process to scrutinise all vacancies”.
It has also transferred business intelligence staff to Royal Devon University Healthcare Foundation Trust, to create a shared BI service, which may have contributed to the reduction.
Buckinghamshire, Oxfordshire and Berkshire West told HSJ it is in the final stages of “implementing a full organisational change programme”, including a “significant reduction” to its pay bill and headcount. The proposals involve axing place directors.
However, the ICB said its marked rise in staff in the year to May may in part be explained by in-housing finance and continuing healthcare teams, and taking on hosting the Thames Valley Cancer Alliance.
Savings elsewhere
Several ICBs said they were reducing the need for staff cuts with savings elsewhere.
Lancashire and South Cumbria ICB chief executive Kevin Lavery told HSJ its large rise in staff — from 455 to 742 — was “largely driven by in-housing a wide range of functions from the commissioning support unit”, with 150 staff transferred.
This work had reduced ICB running costs, because it saved on CSU contracts, he added. The ICB had already carried out a big restructure in 2022-23, meaning it has less still to save from its running costs, it said.
Birmingham and Solihull ICB told HSJ it was “largely able to meet the 2024-25 running cost reduction” through removing vacant posts; targeting “non-pay and recurrent savings”; and a “reduction to our accommodation costs after changing locations”. The 21 per cent rise was due to taking on 89 NHS England pharmacy, optometry and dentistry staff, it said.
South Yorkshire, which saw a small, 1.7 per cent, drop in staff numbers, said in recent board papers it completed the running costs reduction needed in “one go” before March 2024. It held a small voluntary redundancy scheme, but it had made a “significant financial saving” through relocating place-based teams into cheaper, smaller buildings.