Delegation of specialised commissioning from NHS England to Integrated Care Boards

The 2022 Health and Care Act changed how specialised NHS services (including many cancer services) are commissioned. Responsibility is shifting from NHS England to local Integrated Care Boards (ICBs). Cancer Research UK asked the University of Kent to study how this change is working in practice and what it might mean for cancer care.

Researchers interviewed 23 senior staff from ICBs, Cancer Alliances and specialist providers in three regions (East of England, Midlands, North West). They explored how delegation is being implemented, what is working, and what concerns people have.

Key findings:

More collaboration is happening between ICBs, providers and Cancer Alliances. Cancer Alliances are especially valued for their expertise and ability to link organisations. One participant said the alliance provided “a very insightful relationship” when analysing waiting times.

Budget issues are a major worry. ICBs are financially stretched, and specialised budgets are tightly controlled. Some feel delegation is only “partial” because NHS England still holds influence. Others fear that previously ring‑fenced money (e.g., for radiotherapy equipment) could now be diverted.

Governance is complicated. Decision‑making is split between national, regional and local levels, and people are unsure which level should decide what. One interviewee described “oscillation” between national, regional and local control.

Local context matters. Mature ICBs with stable relationships found the transition easier. Less‑established systems struggled more.

Cost savings from prevention are unlikely soon. Although the reforms aim to shift spending “upstream”, financial pressures make this difficult.

Risks identified:

– destabilising specialist centres if patient flows change

– widening inequalities if local services vary

– confusion over budgets and responsibilities

Potential benefits:

– better understanding of local needs

– more tailored cancer pathways

– improved ability to address inequalities

– stronger collaboration across organisations

Measuring success will be difficult. Traditional metrics may not capture the impact of delegation. Some suggested more qualitative feedback, though patient consultation may be harder for highly specialised services.

Overall, the study found promise but also significant challenges, especially around finances, governance complexity and inequalities. Cancer Alliances are seen as crucial, and ICBs’ ability to use local insight effectively will shape how well the reforms work.