Briefing / Developing an effective integrated care board finance team

Integrated care boards (ICBs) are expected to work collaboratively with system partners to deliver the health and care that the population needs. While local systems have been moving towards this way of working for some time, the legislative change has altered the emphasis, seeing a move away from ‘command and control’ to coordination and strategic decision making. Commissioning of services may be carried out by the ICB, by their delegated teams based at place-level, or even within a provider collaborative.

ICB finance staff will need to hone skills of persuasion and negotiation to influence decision making in complex systems, where ICBs have few formal levers. Those decisions will be based on developing a fuller understanding of population needs, through the analysis of activity and financial data from across a system. 

Those charged with creating ICB finance teams are facing one of two scenarios: a CCG may have been a one-to-one match with the new ICB, meaning that finance teams have transferred as they are; or several CCGs may have merged to form one ICB, meaning that restructuring will be necessary to ensure that the team structure makes sense for the new organisation. Both scenarios come with their own challenges. 

While a one-to-one match may appear the simple approach, changing the culture of an existing team will be challenging. It will be very easy to maintain existing ways of working which will negate the opportunities offered by the ICB and wider integrated care system (ICS). For those where CCGs have merged, restructuring of the finance team will be inevitable to make best use of resources. Alongside the design of the team, the ICB will need to consider the human factors at play as people change role, responsibility, and possibly location.

Having a clear view of how the ICB finance team should be structured to fully realise the potential of the new collaborative approach to designing, commissioning, and delivering care, is essential to successfully establish ICBs and support the wider ICSs.

These challenges, and others, were discussed at a HFMA roundtable in June 2022 where designate ICB CFOs came together with other senior finance staff and non-executive directors from a variety of systems and NHS England.

This briefing sets out the key points covered in the discussion and aims to support all ICBs as they develop their finance functions.