30 May 2025 · articles
ICB Consolidation: What It Means for Network Resilience, Security, and System Interoperability
Discover how ICB consolidation impacts NHS digital infrastructure and how Cloud Gateway's platform ensures secure, seamless integration across merged estates.
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30 May 2025
Author: George Stern | Senior Business Development Manager for NHS
The NHS is undergoing a fundamental restructure, with plans to reduce the number of Integrated Care Boards (ICBs) from 42 to between 25 and 28 through clustering and eventual mergers. This move aims to consolidate leadership, reduce duplication, and cut costs. But just as with any structural overhaul, especially in complex public systems, the implications run deeper than leadership structures. This change affects how care is delivered, how systems communicate, and how securely patient data flows across regions.
A Mirror of Local Government Devolution?
What’s happening in the NHS closely echoes the wave of local government devolution seen over the last decade, and particularly the last 12 months. Combined authorities, elected mayors, and pooled budgets have aimed to give regions more control over resources, reduce fragmentation, and deliver joined-up services. The Greater Manchester Health and Social Care Partnership, for example, was one of the first to bring NHS and local government under shared control, effectively a forerunner of today’s ICB evolution.
ICB clustering is the next chapter in this decentralisation journey, reflecting the reality that health, care, and place are deeply interlinked. Just as local authorities are consolidating to form more coherent delivery footprints, so too are ICBs - aligning geographies, financial accountability, and digital infrastructure.
As with devolution, the challenge lies in integration. Combining organisations does not automatically lead to better outcomes unless there is serious investment in shared systems, clarity over governance, and interoperable digital services.
Regional ICB Consolidation: A Nationwide Transformation
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Nowhere is the impact more evident than in the Midlands, but notable clusters are forming nationwide:
Midlands: 11 ICBs reducing to 5 or 6, with significant clustering in both East and West sub-regions.
South East: ICBs expected to drop from 6 to 4, with Frimley joining Buckinghamshire, Oxfordshire and Berkshire West (BOB), and Sussex aligning with Surrey Heartlands.
East of England: Six ICBs could become three, with realignment also expected in Essex.
South West: On course to form three clusters from seven ICBs.
London: May reduce from five to four ICBs.
North East & Yorkshire, North West: Largely unchanged, though some adjustments remain on the table.
The financial benefits of these changes are targeted for Q3 of 2025–26, giving ICBs and partners a narrow window to prepare.
Digital Infrastructure: The Unspoken Pressure Point
At Cloud Gateway, we see a familiar risk from the devolution experience: infrastructure lagging behind policy. If systems, networks, and data access protocols aren't aligned during ICB mergers, the result will be fragmentation masquerading as integration.
3 key digital considerations ICBs should prioritise:
Merging organisations must enable data to move seamlessly - across multiple Electronic Patient Records (EPRs), legacy applications, and cloud services, often with different suppliers, standards, and configurations. Without a unified platform to connect these diverse systems, the promised efficiency gains of ICB consolidation will remain unrealised.
Where there was once a single organisational perimeter, we now have federated environments with overlapping access needs. The risk surface expands significantly. Solutions must be flexible but secure, enabling collaboration without exposing systems to breach.
As ICBs span wider geographies and populations, data ownership becomes more complex. Clarity on who controls what, and how access is governed, will be essential not only for compliance but for clinical confidence. Real-time network analytics and reporting capabilities are crucial for maintaining this visibility.
Lessons from Devolution: Plan the Plumbing
One lesson from local government devolution is this: you can devolve budgets and restructure governance quickly, but you can’t shortcut the infrastructure needed to support it. Inadequate focus on digital and data-sharing undercut the early ambitions of some combined authorities.
ICB leaders should take note: if the backend isn’t designed for scale and interoperability, the benefits of consolidation will stall. That means modernising networks, adopting zero trust security models, and investing in real-time data visibility - not just for the ICB itself, but across NHS providers, social care, and third-party partners.
Cloud Gateway’s Role
We’re already helping NHS organisations connect securely across fragmented systems, enforce consistent policies, and streamline access across hybrid environments. As ICBs evolve, we’ll continue to partner with organisations that need network infrastructure as adaptable as the system it's meant to support.
Final Thought: Strategy Meets Infrastructure
Clustering ICBs isn’t just an operational exercise. It’s a strategic bet on the future of place-based care. But like with local government devolution, the strategy only works if the infrastructure is ready.
Now is the time to make the invisible - networks, data flows, security - a visible priority.
How can Cloud Gateway help?
Find out more about how Cloud Gateway provides fully managed NHS networks.