Recommendations

In the upcoming Model IHO Blueprint, NHS England should: 

1. Empower ICBs and local provider partners to decide whether and how to establish and hold IHO and neighbourhood contracts and what population size they should cover.
2. Establish a transparent process to IHO authorisation that considers the host provider board’s capability to manage population health, effective collaboration agreements, risk-sharing arrangements and ICB capability.

Outside of the blueprint, NHS England should:

1. Update the NHS Oversight Framework and financial and performance metrics for 2026/27 to support a transition from metrics focused on organisational recovery to those that better incentivise transformation and collaboration between organisations. A new set of metrics should be in place by the time the first IHOs become operational in 2027. It is critical to the success of IHOs that national incentives are aligned toward collaborative behaviours and leadership.
2. Support and resource the development of ICBs’ and IHO host providers’ strategic commissioning skills and capabilities, making any changes to policy and guidance needed to allow ICBs’ to delegate some of these functions to IHO host providers over time.

The Department of Health and Social Care should make the following legislative changes: 

1. Ensure high standards of probity and conflict management, by liaising with the Competition and Market Authority to explore compatibility with IHO contracts and, if necessary, assessing whether legislative reform is desirable.
2. Amend Section 44 of the National Health Service Act 2006 to redefine foundation trusts’ 51 per cent income threshold in terms of ‘public sector’ funding rather than strictly ‘NHS’ funding, to enable social care and public health services to be included in IHO contracts.