ICBs Slim Down, Trusts Step Up - implications for digital health
Last week, Sir James Mackey, the new Chief Executive of NHS England, published a letter outlining priorities for 2025/26. It includes some major signals for digital health companies.
At its heart, the letter sets out a vision of a leaner, more accountable NHS, where planning is local, commissioning is strategic and delivery is grounded in operational realism.
For DHC members, this means new opportunities but also important shifts in who holds the power.
Key takeaways
Strategic commissioning remains vital — but ICBs are being reshaped
ICBs are still central to system-wide planning, with a focus on population health, analytics, and market management. But they are being asked to reduce their running costs by 50%, stripping out many delivery and assurance functions.
Expect ICBs to retain strategic oversight, but rely increasingly on NHS providers to implement and manage innovation
Providers are becoming key operational partners
As ICBs slim down, NHS providers (especially acute, community, and mental health trusts) are emerging as more powerful organisations. The letter suggests performance management, comms, assurance and even some commissioning delivery may move into provider space.
To succeed, digital health suppliers must appeal to both ICB-level strategic goals and provider-level operational priorities
Cost-cutting and productivity are at the top of the agenda
The NHS is targeting a 50% reduction in corporate costs, both in ICBs and providers. Releasing funds to the frontline is the ambition.
Solutions that improve workforce efficiency, reduce duplication, or automate admin functions will be in demand but ROI must be clearly evidenced.
NHS Standard Contract reform could unlock enable innovation - with caveats
NHS England has confirmed plans to remove the elective payment cap and introduce a more flexible approach to contracting for 2025/26. Providers and commissioners will jointly plan activity, with greater scope to earn based on delivery. This could create space for digital solutions that help trusts scale elective activity, plan capacity, or optimise pathways.
If you support faster access, elective recovery, or operational efficiency — there may be opportunities ahead. But expect continued uncertainty in how this plays out locally
What DHC is doing behind the scenes
We’re already working closely with members and system leaders to understand how these changes are playing out on the ground.
We’re in conversation with ICB and provider leaders to track how commissioning and delivery responsibilities are shifting
We’re analysing local financial plans to spot where investment in digital is still possible and where it’s getting squeezed
And we’re helping members stress-test their offers to make sure they align with the new strategic reality.