As the NHS system goes through a major reorganisation, Kathy Oxtoby looks at the impact on staff and how health leaders at integrated care boards can support wellbeing in light of redundanciesand mergers
For integrated care boards (ICBs) this is a time of flux and change. Policy changes introduced throughout 2025, have included merging NHS England (NHSE) with the Department of Health and Social Care (DHSC), cutting ICB budgets by 50% – which equates to reducing staff by about 12,500 across the health system – and the clustering of ICBs
Research by The Health Foundation carried out with local system leaders throughout 2025, has found that ‘recent policy changes including scrapping NHS England, cutting ICB budgets, merging them across larger geographical areas and redefining their role were causing widespread disruption and – paradoxically – distracting ICS leaders from delivering on the government’s ambitions for reform’, says Phoebe Dunn, senior policy fellow at The Health Foundation
‘Leaders identified a mix of risks arising from the latest round of NHS restructuring. These included concerns about draining capacity and focus from local systems, loss of ‘goodwill’ and ‘additional effort’ among front-line staff, and the negative impact on morale within their organisations. Leaders vividly described the human impact of the budget cuts on ICB staff,’ she says
Responses to ICB cuts, mergers and the overall move towards fewer, bigger ICBs were largely negative, the research found. ‘Leaders were scathing of the handling and subsequent management of the announcement to cut ICB running budgets by 50%, described by different leaders as ‘disgraceful’, ‘unprofessional’ and ‘an absolute shitshow’,’ the report says
In the report, leaders described how colleagues were ‘on their knees’, the ‘terrible, terrible morale’ and the ‘cold, hard reality’ of looking around the office and thinking ‘somewhere between 45% and 50% of you guys won’t be here’
Interviewees also described ‘the major impact of the cuts and wider reorganisation on people’s time and energy’. ‘For example, senior leaders now had to work on agreeing the design of new ICB clusters in their region, running staff briefings and support for people at risk of redundancy, and more,’ the report said
As well as the impact on morale and staff engagement, leaders also had concerns about staff turnover and where that might leave capacity and capabilities in their already-stretched organisations, the report found
‘Staff face increased workloads, unrealistic deadlines and uncertainty about their futures. They’re worried about the quality of the services they provide,’ says Alan Lofthouse, Unison deputy head of health
Dr Sonya Wallbank is a senior consultant, clinical psychologist, was previously a chief people officer for an integrated care board, and also runs The King’s Fund’s Network of Chief People Officers, which supports some ICBs and other organisations.
Dr Wallbank is ‘amazed at how resilient and how effective ICB staff remain – even to the end of their contracts’. However, she says people not knowing whether their work is valued, ‘puts them in a different space’. They may ask themselves: ‘What’s the point?’ ‘Am I being effective?’ ‘Are there other things I might be doing with my time?’, and ‘Is this happening to me because of my capability, rather than a decision that’s been made away from the work that I’m doing?’, she says.
The negative impact of the recent changes is reflected in the rise in sickness and absence staff numbers. Then there is presenteeism. ‘There’s that sense of: ‘I’m still here, I’m on my computer, but I’m just not feeling 100%’. We know that that is how some people cope with what’s happening to them,’ says Dr Wallbank
There is also the uncertainty that comes from working in an environment where people feel ‘there won’t be a career for me, there won’t be a role for me here’, she says
Morale among ICB staff will vary depending on their organisation, she says. But the recent NHS staff survey shows the impact of change on ICBs that indicates in some places: ‘this is not a great place to work at the moment’
With so many challenges and issues to contend with, and consistent change, staff, including ICB leaders, are at risk of burnout, she says.
Then there is ‘that loss of exceptional talent, knowledge and skills from people leaving jobs that they’ve been in for decades’
With the role of ICBs changing and goals shifting, ‘this makes it difficult to see your work as effective’, she says
‘And people are losing confidence in their ability to respond and react, so they are withdrawing from conversations’, she says. This can result in ‘really skilled people not delivering the most effective work’
ICB leaders are also working their way through a series of other major changes, says the Health Foundation’s Ms Dunn. ‘Many have recently merged or clustered together and their role has been refocused to act as ‘strategic commissioners’.’
And more changes are on the way, with potential for further ICB mergers in 2027and proposed changes to their governance, commissioning responsibilities and oversight currently working their way through Parliament as part of the Health Bill, she says. ‘Changes to other parts of the NHS – the newly reshaped centre and regional arms, and the implications of new integrated health organisation (IHO) contracts – are also still emerging
‘There’s continued uncertainty about the roles and responsibilities of ICBs, NHS England, the Department of Health and Social Care and the new regions,’ says Unison’s Mr Lofthouse. ‘Voluntary redundancy schemes not cutting enough jobs in ICBs which means they’ll have to make compulsory redundancies next.’
Mr Lofthouse says the focus for national bodies and the government should be on ‘how their actions and decisions affect ICB staff’
‘There’s a lack of understanding on what will be needed in reorganisations resulting from government announcements on job cuts. Staff facing redundancy are having to make difficult life decisions and urgently seeking pensions information for example. Yet the NHS Business Services Authority (NHSBSA) has struggled to cope with these demands. Additional re been planned for in advance.’
NHS cutbacks ‘reduce the ability of staff in human reays ‘They’re also hampered by a lack of national clarity on policy and instruction – or by shifting goal posts.’
He says staff have raised ‘significant concerns with Unison about unsafe services and staffing levels in ICBs’. ‘As people leave teams, those that remain face an additional work burden. Employees should be at the centre of organisational change but this hasn’t been the case.’
The NHSBSA says it recognises the pressure pension uncertainty brings and that recent estimate requests are completed in an average of 18 days
A spokesperson for the NHSBSA said: ‘We recognise that pension uncertainty adds significant pressure for NHS staff facing redundancy, and we take this extremely seriously.
‘Pension estimates can only be produced once we receive both the request and necessary data from employers and payroll providers. When NHS England’s payroll provider began issuing data to us on 1 April 2026, we started processing immediately. As of 13 July 2026, we have received 3,195 estimate requests and completed 3,062, with recent requests completed within an average of 18 working days.’
They added that the service has ‘increased and upskilled [the] re
ICBs have become ‘well versed in managing the challenges that are thrown at them’, says Dr Wallbank. When managing staff concerns around big changes to the NHS, it is important for ICBs to ‘share the work plan openly’ she says
‘Staff remain concerned about work they’ve put their heart and soul into just being cast adrift, because there won’t be anyone to pick it up. Having a clear plan of what’s happening with programmes of work being handed over, paused, or done differently, is important,’ she says
‘As staff get new jobs or move on, knowing that their work is valued is going to leave them in a better space psychologically to be able to move on well.’
ICBs need to clarify what the changes might mean, she says. ‘There have been vacuums of information, and staff aren’t necessarily aware of, for example, whether there will be further downsizing. Jobs are remaining at risk for lengthy periods. This is not how we usually manage change in the NHS
‘It makes it very difficult for people to settle and give attention to their work. So, it’s about that firming up of ‘this is the plan’, at least for a period of time, and then involving teams in the discussions,’ she says
‘Staff are feeling a bit ‘done too’, and are not being able to provide suggestions for change,’ she says. ‘ICBs need to take the time to hear the voices of those who remain within the organisation about what might be done better, quicker, and more effectively, and to give that sense of agency to people who have felt out of control for a while now.’
As to how ICBs are maintaining and supporting staff at a time of uncertainty, ‘there’s a variety of response’, says Dr Wallbank. Some ICBs are ‘getting it right and being really supportive of staff, and others, perhaps through financial constraints, are offering less and are very limited in what they’re able to offer’
Regarding ICBs supporting staff through job cuts, some ICBs are doing work around talent management, she says. They are offering placements in organisations connected to the ICB – such as local authorities and charities – to give staff an experience of what a particular role might be like before they have to make a decision. ‘This is a great way of enabling the best skilled people to be retained in the system.’
Some ICBs are offering career coaching. ‘It’s about having somebody walk alongside you to support you both emotionally and practically on that journey’, she says
There are also examples of where organisations are ‘working hard to not only support those people who are leaving, but to regain the attention and support of the people who are staying’, she says
And in some areas, staff health and wellbeing hubs are in place, however, they are no longer centrally funded from NHS England
Some ICBs are providing individual support to staff and ‘most already offer basic employee assistance programmes’, says Mr Lofthouse
ICBs ‘need to recognise the impact of changes on staff and to offer more support with workloads’, says Mr Lofthouse
ICBs should also ‘think of the health and wellbeing needs of the team’, says Dr Wallbank. ‘It’s not just about following the formal process – it’s about how do you leave people feeling intact, the best version of themselves, and ready to be interviewed for their next role.’
Uncertainty, not just about what is happening now but also in the future, is creating anxiety among staff, she says. ICBs should be clear about ‘where they are going and what they are working on’, and offer stability with these conversations
They need to ‘think through how outplacement support could work for staff, especially staff who’ve been in the same job and haven’t done an interview for a long time’, she says
While some organisations are ‘getting this right’, Dr Wallbank would like to see ‘a national call for what an outplacement support package should look like’
ICBs should consider how the changes have impacted on remaining staff and how they work with them, ‘to create that sense of security and permanence that allows them to do their best work and not have to be thinking: ’is my job safe?’, she says
And she says the ‘weight of responsibility that’s on chief people officers (CPOs), whose role has also been put at risk, is a constant theme in our Chief People Officer group, and ICBs need to pay attention to how we are supporting those senior roles’
‘To avoid the fate of previous reforms to NHS commissioning, policymakers will need to actively construct the ‘strategic commissioners’ that it wants ICBs to become and ensure the skills and capabilities are in place to support it,’ says Ms Dunn. ‘Beyond this, providing clarity and stability to ICBs about their future role and structure – then leaving it alone for as long as possible – should be a priority for the government.’
‘ICB staff should be properly valued,’ says Mr Lofhouse. ‘They do unseen jobs that have a positive impact on people’s lives and ensure the NHS functions safely and effectively.’
