NHS Reform | News centre

NHS reform and changes to Integrated Care Boards 

Earlier this year, the government announced significant changes to the NHS landscape aimed at strengthening roles and responsibilities across the wider NHS and reducing duplication, so more funding can be directed to frontline care.  These changes signal a leaner way of working, where every part of the NHS is clear on their purpose, what they are accountable for, and to whom, and will help support delivery of the recently published 10-year Health Plan to improve outcomes for patients and communities.

As part of this NHS reform, Integrated Care Boards (ICBs) have been asked to significantly reduce their operating costs (by approximately 50%) and focus on their critical role as strategic commissioners - working to improve population health, reduce inequalities and improve access to more consistent high-quality care.

This represents a step-change in ICBs’ leadership and responsibilities and an opportunity to create a fundamentally different kind of organisation focused on improving the health of our local population. 

After careful consideration, the Boards of NHS Surrey Heartlands and NHS Sussex agreed to pursue plans to collaborate and create a new organisation spanning the two counties.  In summary, our collective plan sets out a vision for one ICB working over Surrey and Sussex (including the Farnham and Surrey Heath areas of Surrey which currently sit within the Frimley system). This plan was submitted to NHS England on 31 May 2025 and has received formal support from ministers and NHS England.

We are now working to create a brand-new organisation from 1 April 2026, responsible for a population of just over three million.

Why Surrey and Sussex?

NHS Surrey Heartlands and NHS Sussex share a proud history of collaboration - grounded in mutual trust, aligned values, and joint delivery across commissioning, workforce, and clinical innovation. From integrated planning to shared leadership development, we have demonstrated what purposeful collaboration can achieve.

There are also long-established health partnerships across the two systems with the Surrey & Sussex Cancer Alliance, Surrey & Sussex Local Medical Committee and Community Pharmacy Surrey & Sussex, as well as NHS providers such as Surrey & Sussex Healthcare NHS Trust, South East Coast Ambulance Service NHS Foundation Trust, Queen Victoria Hospital NHS Foundation Trust, Royal Surrey NHS Foundation Trust and University Hospitals Sussex NHS Foundation Trust who provide NHS services to patients in both Surrey and Sussex.

An opportunity to build a brand-new organisation with a clear focus  

This change provides us with an opportunity to create a brand-new organisation, building on the strong foundations we have individually built and bringing those strengths together to deliver for our collective population. 

By working together, we will be able to use these collective strengths and clearer focus – across both the Surrey and Sussex systems - to align funding and resources strategically with the improvements we want to see to the long-term health outcomes of our populations.

We know that across Surrey and Sussex outcomes could be improved related to cancer, to cardiovascular disease and respiratory conditions. We also recognise that across Surrey and Sussex our population is ageing faster than the national average and this brings with it specific needs for NHS care and support.

By working together, we will be able to use our collective resources and expertise to drive forward this approach to improving outcomes. We will commission services to reduce inequities in health outcomes and access, and through our contracts with providers ensure that improvements are made to the way health and care services support our local population.

Aligned with the model ICB blueprint (published in May 2025), we will act as a system leader, architect, and steward. Our unique role will be to coordinate the allocation of resources; we will be accountable for getting the best use of our population’s health budget by aligning funding and resources strategically with long-term population health outcomes.  Importantly we will have a responsibility to use our understanding of the local context to make sure that every pound spent is improving outcomes, tackling inequalities, delivering best value, and building long-term health resilience for our populations, including the left shift.  

This also offers significantly better value for the taxpayer, supporting a shift of greater resource to the frontline.

Developing the right model

To focus on our role as a strategic commissioner, we need to develop a new operating model which will be based on a set of core functions.  These will include areas such as population insights and analytics; quality and patient experience; strategic commissioning, strategy and planning; finance and contracting; and statutory and corporate services.

This also means there will be some functions that ICBs currently undertake that we will no longer be responsible for, with some responsibilities moving to the NHS England region, some to other providers and some hosted by other ICBs on behalf of larger footprints including across the South East. The detail around these functions is still being worked through with further communication and engagement to come.

Preserving local relationships and focus

Whilst we will be coming together across a much wider footprint, we know that real change happens locally - at neighbourhood level – which is a key focus of the 10-year Health Plan. That is where relationships are strongest, knowledge is deepest, and integration is most feasible.

Both systems have strong roots in neighbourhood health with lots of examples of local partnerships driving transformation.  We will build on these strong foundations as we develop our new organisation ensuring we embed local relationships into the way we operate and continue to build on local strengths. 

In creating one new ICB we will be working as key and integral partners within our two systems – Surrey and Sussex – and across our five ‘Places’ – Brighton and Hove, East Sussex, West Sussex, East Surrey and West Surrey. We will work closely with all our existing local authority partners, recognising they are also going through change themselves and will work in partnership to realise the benefits of the creation of new unitary authorities in Surrey and Sussex and the outcomes of future local government configuration.

Working with our partners and communities

As our plans continue to develop, we remain committed to keeping partners across both systems informed and involved throughout this journey.  Our approach will continue to be fully inclusive of patients and their families, the voluntary, community and social enterprise sector, unpaid carers, and social care providers, and we are committed to designing systems that reflect this inclusivity and build on local relationships.  Listening to and working with people and communities will run right through how we operate, ensuring that we understand and act on what we hear, commissioning the right services, in the right way for local people.

Impact on our staff and current functions

Of course, these changes will have an impact on how we currently operate and on our staff. Managing colleagues through these changes, and the inevitable reduction in staff numbers, is a key priority during this period of change and we are working hard to support colleagues as best we can.  These changes will also have an impact on some of the functions we currently deliver.  As we seek to implement the Model ICB Blueprint and streamline our activity, there will be some functions best provided across wider geographies, including across the South East.  Some functions may also transfer to other providers over time, with timescales and specific functions still to be agreed. We will be working closely with our staff and wider partners to ensure these transfers operate as smoothly as possible. 

Latest position

As we take forward the transition required, on 1 October 2025 we reached a significant milestone, as both organisations started to work as a cluster together.

Ian Smith was appointed as Chair for both organisations, and on 15 October Karen McDowell became Chief Executive for both NHS Surrey Heartlands and NHS Sussex ICBs. An appointment process will take place next for Executive and Non Executive Directors ahead of the ICB Boards meeting in common in November.

Both organisations remain statutory bodies, but there will be increasing work together to maximise the benefits of the strong foundations and partnerships in place across Surrey and Sussex.

Looking to the future

Together, we recognise that the three million people across Surrey and Sussex are the people we are here to serve – they are our families, our friends, our neighbours, our communities, our colleagues. They are the people we come to work for each day currently – and they will continue to be the reason we strive to improve care, to innovate, to design new pathways, and transform health and care to enhance the outcomes for our populations. 

We are determined that the new ICB will take the best from both our systems and become the excellent strategic commissioner we need it to be.  Our collective ambition is to improve the health outcomes, reduce the health inequalities and secure the best value for money from NHS services for the population of three million people living in Surrey and Sussex in line with the Government’s 10 Year Health Plan.  We are confident that we will achieve this and are excited about the journey to get there and what we can deliver as a result for our organisation, for our health and care system, and ultimately for our population.