Same cycle – different bike?

Change is the only constant in health and care leadership, and with change comes opportunity. As a consultant in public health working in an integrated care board (ICB), the changes laid out in the 2025 ICB model blueprint and backed up by the 10 Year Health Plan for England feel significant. They seek to establish a renewed focus on strategic commissioning, which demands a stronger emphasis on population health. 

The concept of strategic commissioning is not new. It shares parallels with World Class Commissioning (WCC), an NHS strategy introduced in 2007 to raise commissioning standards and improve outcomes. WCC introduced a framework for commissioning that aimed to deliver the maximum improvement in health from available resources – centred around a cycle that closely mirrors the approach described in the blueprint today. 

Although there are similarities between WCC and the 2025 ICB model blueprint, the context in which we now operate is fundamentally different – a case of same cycle, different bike. 

My own journey into public health, which began in 2007, was influenced by the approach to WCC. It sparked my interest in public health and the potential to address health inequalities through service planning and design. This steered me towards public health training, leading to my current role as Deputy Director for Population Health in West Yorkshire NHS Integrated Care Board – a role where strategic commissioning is once again taking centre stage.  

Today’s ICBs are developing in an era marked by stalling health outcomes, widening inequalities, increased demand and declining public satisfaction. NHS funding has increased in real terms over the past two decades, but the pace of rising need and demand means we must now focus more than ever on value.  

Risk factors for poor health have shifted since 2007 – smoking prevalence has halved but obesity has increased. The pandemic exacerbated pressures on the NHS, contributing to longer waiting times and greater unmet need. Public satisfaction with the NHS has fallen to less than half of what it was in 2007. 

Structurally things are different, too. Previous commissioning organisations in the health sector have undergone considerable reform. The abolition of primary care trusts and strategic health authorities in 2012 marked the end of the original WCC programme. Core public health functions were transferred to local authorities, enabling a greater focus on determinants of health. However, this transition also led to reduced specialist public health input into NHS decision-making – a gap that remains evident today. 

The 2025 ICB blueprint repositions population health as a cornerstone of strategic commissioning and raises an important question: where will the capability come from to deliver these functions? Many of the capabilities outlined align closely with the established health care public health competencies. This presents an opportunity for the NHS to re-integrate dedicated public health specialist expertise into strategic decision-making, ensuring equitable access to skills and insights across systems. 

So what public health capability is needed to make ICBs fit for the future as strategic commissioners? 

As health care interventions expand, prioritising effectively to maximise value is an essential skill. Strategic finance leads and public health professionals in ICBs will need to join forces to ensure that resource allocation is both efficient and equitable, best meeting population need.  

One positive development since 2007 has been the advance in digital capability. The NHS’s progress in population health management, including data linkage and risk stratification, has created the foundations for intelligence-led commissioning. Public health specialists have a key role to play here, translating intelligence into actionable insight that informs strategy.  

However, public health leadership is not just about the technical capabilities; it is integral to whole-system leadership.  

Public health leaders are convenors who forge and sustain partnerships with the aim of improving outcomes. West Yorkshire is an example of how this can be harnessed when leaders grasp the value of public health across an integrated care system. Over the past five years we have built an improving population health function that provides an infrastructure for sectors to convene on such activities.  

Through this work we now have dedicated specialist public health capacity embedded in different parts of the system, including in the West Yorkshire Combined Authority and the West Yorkshire Mental Health Provider Collaborative, as well as in the integrated care board. Directors of public health are key to this partnership, and we work closely with local authority public health teams. This has enabled us to be responsive to changing need in a complex health and care system over a large population footprint.  

Maintaining these relationships is critical in aligning NHS services with local needs assessment and broader health improvement priorities. This will be crucial in supporting the three shifts proposed in the 10 Year Health Plan. Whatever the future requirements of ICBs, the role of collaborative public health leadership across the health care system is crucial.  

2025 is undoubtedly a pivotal time to be working as a public health specialist in the NHS. Although population health capability has evolved in pockets, the ICB blueprint now positions it at the heart of the commissioning model and gives us the lever required to take this evolution to the next level.  

In the past five years, we’ve seen increasing maturity in population health approaches in some ICBs. The proposed changes have the potential to accelerate this and bring greater consistency across the country. 

Given current capacity constraints, the key will be equipping a broader range of system leaders with the skills to commission based on need. Equally important is the continued development of system intelligence functions as an enabler to provide actionable insights for commissioners. 

The explicit inclusion of population health in the ICB blueprint is a welcome development, allowing public health professionals to take a more prominent role in shaping health services that drive better outcomes. Now is the time for public health professionals to step up, speak out, and show what we can bring to the table.