Model region blueprint sent to NHS leaders

The 10-year health plan for England (10YHP) commits to reshaping the NHS operating model to support its vision. A key part of the plan is the abolition of NHS England (NHSE), merging its functions into the Department of Health and Social Care (DHSC), and redesigning the centre to create a more agile, less bureaucratic NHS. The role and functions of the regions are integral to getting this right.

Sent to chairs and chief executives of all provider trusts, foundation trusts and integrated care boards (ICBs) on 8 September 2025, the Model region blueprint (requires access to NHS Futures) begins to explain the role of the seven regions as the ‘leadership interface between the centre and local health systems, overseeing strategy, managing performance and coordinating improvement and intervention’.

To support trust leaders to understand the proposals, this briefing summarises the blueprint. If you have comments, feedback or questions please contact our senior policy advisor Izzy Allen, or our policy advisor Emily Newton.

Context

The vision in the 10YHP is of a simplified, rules-based operating model which, as recommended in the Darzi review, clarifies roles and accountabilities and streamlines the multiple touchpoints between the centre and providers. This blueprint sets out a high-level description of the core functions, activities and enablers for the new DHSC regions from April 2027 though it asserts that ‘it is vital that we embed this vision at pace’. 

It identifies three ‘critical aspects’ which need to work for the vision to be achieved: 

• Vertical coherence between parts of the system – clarity about purpose, functions and accountability, and no duplication
• Horizontal coherence – aligned functions, capabilities and enablers 
• The right culture, interfaces and ways of working 

As the Model ICB (requires access to NHS Futures) sought to begin to establish greater clarity about the role and functions of ICBs as strategic commissioners, so the Model region aims to set out a parallel framework clarifying the new performance management and improvement support approach in the NHS. 

The document states that as the DHSC/NHSE merger progresses, more work will be done to iterate the operating model “in partnership with national and local leaders”. The final model will be subject to the legislative changes required.  

Purpose and core functions

The updated NHS operating model positions regions as integrators, bringing together local and national teams, enabling a full view of the performance of providers and commissioners across their geography and being accountable for the region’s health system performance. They will support improvement where needed, and work closely with national teams to instruct relevant interventions.  

Regions will be responsible for understanding regional performance against the ambitions of the 10YHP and creating the conditions for success e.g. through transformation at scale, developing regional strategic partnerships, and supporting planning, reconfiguration and investment.

The blueprint sets out three core functions for regions: 

1. Strategic leadership

• Develop and oversee the implementation of a regional medium-term strategic plan driving delivery and including the regional financial strategy (revenue and capital), service configurations, workforce planning and regional digital strategy. 
  
  
• Implement the NHS planning framework, assure ICB and provider response to national planning mandates and support the right conditions for ‘effective, integrated planning’. Convene annual winter preparedness planning.
  
  
• Support for system development. Oversee provider and ICB reform and transformation, including oversight of service reconfiguration and plans to address unsustainable and/or fragile services. A role in identifying candidates for new foundation trust assessment and integrated health organisation development and providing strategic oversight of neighbourhood health plans and delivery models.
  
  
• Promote research and innovation. Support the development of new regional innovation zones, oversee ICB and provider research performance, and health innovation networks.
  
  
• Coordinate HR, leadership and talent management, support whole-system strategic workforce planning, and deliver professional development. 
  
  
• Lead regional digital transformation and innovation at scale including health technologies, AI and remote monitoring. Act as a hub for specialist expertise and clinical digital leadership for local deployment. 

2. Performance management and oversight

• Real-time operational oversight of provider performance and ICB performance and commissioning. Review provider capability self-assessments and ensure local plans are aligned with 10YHP ambitions. Oversee annual performance assessments of ICBs, provide oversight of the transfer of commissioning functions to ICBs and facilitate inter-regional ICB collaboration as needed.
  
  
• Oversight of provider and ICB board capability and capacity. 

3. Improvement, support and intervention 

• Oversight and coordination of improvement, spread and scale best practice and innovation, support capability development in providers and ICBs, and facilitate rapid quality reviews. 
  
  
• Address challenged performance or organisations, monitor risks and trigger interventions where required. Regions will have access to national improvement expertise to support this work. 
  
  
• Support ICBs, assess ICB capability, and support the development of strategic commissioning capability in line with national guidance. 
  
  
• Support learning and development of clinical and non-clinical leaders, provide professional lines of accountability and support, support governing bodies with improvement strategies. 

Other activities that will be further developed include: 

• As part of DHSC, regional teams will have a wider remit than at present, likely bringing in functions not covered by NHS such as social care and public health. 
  
  
• Support the development of seven new ‘offices of pan ICB commissioning’, enabling the transfer of all remaining commissioning responsibilities to ICBs following expected changes in legislation.
  
  
• Professional standards, regulation and leadership. 

Enablers, capabilities and next steps 

The blueprint sets out what will be required to enable the new regions to undertake these core functions.  

• A new regional governance model: Strengthened regional governance and leadership will support a rules-based model that builds capability of provider and ICB boards. Regional CEOs will have ‘a clear line’ to the CEOs of providers and ICBs. A new role of ‘regional chair’ will be created, to support provider and ICB non-executive directors (NEDs) and provide assurance to the national centre about NED capability. 
  
  
• The right capabilities and expertise: The regional senior leadership team should consist of people experienced at board level in providers and/or commissioning organisations, focusing on quality interactions with NHS senior leaders and strategic authorities, not on programme delivery or coordination. 
  
  
• Access to resources and levers for improvement and transformation: The regions require resources to support improvement, and will need their own capability as well as using national expertise, resources and budgets. They will also autonomously direct investment (capital and digital) to support agreed medium term plans aligned with the 10YHP. 
  
  
• An effective ‘one team’ culture across the centre, with clear roles and responsibilities. 

Two programmes of work will ensure effective communication and transition planning with ICBs and providers. The new operating model programme board is working on the interface between regions providers and ICBs, including the process for the regions to take on their new performance oversight role from the second half of 2025/26. A joint DHSC/NHSE England transformation programme is redesigning the centre in line with the 10YHP. Both programmes commit to engaging with local leaders as work progresses. Questions can be directed to england.new-operating-model@nhs.net. 

A fit for purpose operating model is essential to deliver the 10YHP. It is no small task, and it is welcome that NHSE/DHSC are taking an iterative approach. This is essential due to the time needed to pass relevant legislation to reallocate functions but will also enable meaningful engagement with NHS board members: the necessary time should be taken to get this right.

It’s essential that the final model is well-worked through so it delivers the three ‘critical aspects’ set out in the blueprint. The 10YHP’s ambitions to streamline the centre, clarify roles and accountabilities, instil the right culture, and support enhanced provider autonomy must be enabled, not hindered, by the model.

While the ‘right culture’ is undefined, the blueprint pays welcome attention to ways of working and relationships. However, the functions allocated to the regions may make it challenging to establish the open and transparent improvement cultures needed for success. Specifically, undertaking both oversight and improvement in the regions introduces tensions (and the potential for the marking of own homework) that will need to be managed. The interactions between regional directors and provider and commissioner chairs and chief executives must not revert to command and control and holding both support and oversight functions in the same place exacerbates this risk. We have long called for an independent regulatory body to resolve many of these tensions and improve the quality and validity of oversight, and enhance relationships and culture. More work also needs to be done to clarify the role of the regions in routine performance management and in regulatory oversight.

There is an overarching question as to whether the regions operate in the service of the commissioners and providers (and ultimately patients) or vice versa. The tensions between functions – oversight and support, performance management and coordinating transformation – that have at times hindered NHSE regions’ effectiveness remain embedded in this blueprint as it stands. 

A new role of ‘regional chair’ is proposed, charged with both support for trust and ICB NEDs and oversight of their capability. The use of "chair" for this role, and for the regional "chief executive" role, is confusing, since the DHSC regions are proposed to be only part of DHSC, not separate organisations, and there is no mention of them having a board. It is also unclear who would appoint a regional chair and to whom they would be accountable. Legislators are likely to take an interest in this when the health Bill is introduced.

In addition, mixing support and oversight functions within the role of both the regional leaders is unlikely to lead to either effective support or the creation of open cultures. Support for NEDs is needed but tasking regional "chairs" with this risks duplicating the role of provider chairs, who are responsible for NED capability in a unitary board. In doing so it would potentially undermine the unitary board model itself. 

More work is needed, as the blueprint acknowledges, in many areas. Specifically, on: 

• The degree of standardisation introduced by regions, for example in relation to quality improvement and digital, and how much room there is for provider choice. 
  
  
• The role and accountabilities of strategic authority mayors and chief executives, including in relation to service reconfigurations.
  
  
• The potential duplication that remains between functions of ICBs and regions, e.g. on digital leadership. 
  
  
• How the ‘offices of pan ICB commissioning’ will be established and operate, and how they may address commissioning of specialised and ambulance services. If these offices support regional commissioning, this is likely to be welcomed by the ambulance sector. 
  
  
• The implications of the regions having autonomy to direct some capital investment. 
  
  
• The criteria for accessing the hub for specialist expertise. 

We and our members welcome continuing engagement with NHSE and DHSC to support the development of the operating model.