NHSE delays delegation of key services to ICBs

In a letter to ICBs and regional teams last week, Steve Russell, NHSE chief delivery officer and national director for vaccinations and screening, and Julian Kelly, chief financial officer, said it had decided to push back the handover from April 2025 to April 2026.

This is due to a “wider review” of how best to delegate and commission screening services, NHSE said.

The services concerned cover vaccination, some elements of screening pathways, and child health information services (which manage public-health focused electronic health records for all children).

There have been several failures in screening services over recent years, and are concerns about falling vaccine uptake post-covid. They are important public health interventions, and could be subject to attempts by the new government to boost prevention.

As with other delegated services, there are also likely to be concerns about splitting up staff expertise and capacity when commissioning is divided across 42 ICBs.

The new letter says NHSE will work with ICBs to determine “the suitability of services and functions for delegation”, “the most effective commissioning footprints” and “ensure readiness for the changes” before handing over control in April 2026.

It is the latest in a swathe of direct commissioning responsibilities NHSE is handing over to ICBs. 

Primary care commissioning has already been delegated; and the letter confirms NHSE will press ahead with passing over 70 specialised services to all ICBs in April next year, on top of the 59 already delegated to ICBs in the East of England, Midlands and North West regions. 

It will transfer specialised commissioning staff — who have all remained in NHSE during 2024-25 — to one host ICB per region by April.

For all delegated functions, NHSE will develop “comprehensive arrangements” for “oversight and assurance” by April 2025, the letter added, and will consult with trade unions and staff before they are transferred.

There are no plans to delegate commissioning of health and justice or sexual assault and abuse service functions, NHSE said.

When primary pharmacy, ophthalmology and dentistry services were delegated in 2023, there were concerns over capacity for transformation work, and availability of monitoring data. 

Delegation of specialised services has met with opposition over many years from large specialist providers, specialist medics and researchers, and some patient groups.