Wes Mountain
Delivery of integrated care board (ICB) functions have not been adequately protected during a reorganisation of the bodies, some Royal College of Pharmacy (RCPharm) members have said.
In written evidence sent to the the House of Commons Public Accounts Committee inquiry into ICB reorganisation in October 2026, the College said: “While experiences may vary, there have been reports of rapid and seemingly indiscriminate reductions in headcount before a functioning replacement system has been designed and established, including the loss of experienced leaders and technical specialists.”
The inquiry was opened in July 2026.
In March 2025, the government announced that ICBs would be required to reduce their running costs by 50%, adding that NHS England would be abolished and its responsibilities brought under the Department of Health and Social Care (DHSC).
Then in September 2025, NHS England announced plans to reduce the number of ICBs through mergers and boundary changes, which resulted in the closure of some ICBs as part of the mergers. Originally planned to be completed by April 2027, the deadline for the reorganisation was later extended until April 2028.
As the changes proceed, “strong strategic clinical leadership remains essential and should be treated as an investment in the effective use of NHS resources”, the College said in its evidence.
“Clinical leaders bring expertise that supports evidence-based commissioning, pathway redesign, quality improvement and population health management. While removing these functions may release an immediate administrative saving, they can also lead to increased prescribing costs, avoidable harm and demand elsewhere,” it added.
Elsewhere in its evidence submission, RCPharm noted that some members have warned that ICB “capacity has been removed while responsibilities remain, often without an agreed alternative delivery arrangement or a realistic assessment of the capability needed to fulfil them”.
“[This] could leave ICBs accountable for outcomes without the practical means to influence them,” the College said. It also explained that, therefore, national contractual arrangements, including in primary care, need to support the outcomes that ICBs are expected to secure.
The College stressed that with the abolishment of NHS England, pharmacy expertise must remain a key influencer of government policy — particularly around matters including medicines shortages, aseptic services and the reduction of hospital admissions from problematic polypharmacy and adverse drug reactions.
The public accounts committee is due to hear from representatives of NHS England and the DHSC at an in-person evidence session to be held on 16 November 2026.
