Working With ICBs in Mental Health: What Providers Need to Get Right

Integrated Care Boards (ICBs) are now central to the planning, commissioning and oversight of mental health services across England. While providers continue to deliver frontline care, ICBs increasingly shape strategic priorities, allocate resources, monitor performance and coordinate system-wide transformation. Mental health providers must therefore build mature, transparent relationships with ICBs that extend well beyond routine contract management and demonstrate their ability to contribute positively to wider Integrated Care System (ICS) objectives.

This article forms part of the Mental Health Services Knowledge Hub and should be read alongside Working with ICBs, NHS Trusts & System Partners, Service Models & Care Pathways, Quality, Safety & Governance and Community & Integrated Mental Health Care.

Commissioners increasingly regard providers that work proactively with ICBs as strategic system partners, recognising that open communication, shared leadership and collaborative problem-solving help create safer, more sustainable and better coordinated mental health services.

Understanding the strategic role of Integrated Care Boards

ICBs oversee the planning, commissioning and assurance of NHS-funded mental health services while working closely with NHS Trusts, local authorities, voluntary organisations and independent providers. Their focus extends beyond individual contracts to improving outcomes across the entire local population.

ICBs typically lead:

• Strategic commissioning.
• Population health planning.
• Performance oversight.
• Financial stewardship.
• Quality assurance.
• System transformation.
• Partnership development.
• Integrated care planning.

Providers that understand these broader responsibilities are better able to align their services with long-term commissioner priorities.

What ICBs expect from mental health providers

Commissioners increasingly look beyond compliance with contractual requirements. They expect providers to demonstrate operational maturity, transparency and a willingness to contribute to wider system improvement.

Strong providers routinely demonstrate:

• Reliable operational leadership.
• Accurate performance reporting.
• Early identification of emerging risks.
• Constructive engagement with transformation programmes.
• Collaborative working across organisations.
• Continuous service improvement.

Providers that communicate openly and proactively are often viewed as trusted long-term partners.

Operational example 1: supporting an ICB transformation programme

An ICB launches a programme to improve community mental health access and reduce avoidable crisis presentations. Rather than simply responding to contractual requests, a provider actively contributes to system planning.

The organisation supports the programme by:

• Sharing pathway performance data.
• Identifying operational challenges.
• Participating in redesign workshops.
• Testing new referral processes.
• Monitoring implementation.
• Reporting learning through partnership meetings.

Commissioners value this collaborative approach because it demonstrates commitment to wider system improvement rather than organisational interests alone.

Building effective day-to-day relationships

Strong relationships with ICBs develop through consistent operational engagement rather than infrequent formal meetings. Regular communication enables providers and commissioners to anticipate pressures before they affect service delivery.

Routine engagement may include:

• Contract review meetings.
• Operational delivery groups.
• Quality assurance meetings.
• Strategic planning forums.
• Clinical governance discussions.
• Transformation programme boards.

These regular conversations strengthen trust while supporting collaborative decision-making.

Using performance data to strengthen partnerships

ICBs increasingly expect providers to present data that supports learning and service improvement rather than simply demonstrating contractual compliance.

Useful information typically includes:

• Referral and activity trends.
• Access and waiting time performance.
• Recovery outcomes.
• Patient experience feedback.
• Audit findings.
• Learning from incidents and complaints.

Commissioners value providers who interpret data thoughtfully and propose practical improvement actions.

Operational example 2: responding to deteriorating performance

A provider identifies increasing waiting times caused by workforce shortages. Rather than waiting until the next formal contract review, the organisation engages the ICB immediately.

Working collaboratively, both organisations:

• Review performance data.
• Assess operational risks.
• Agree temporary mitigation measures.
• Monitor recovery plans.
• Provide regular progress updates.
• Review outcomes jointly.

This proactive approach strengthens commissioner confidence and reduces the likelihood of more significant service disruption.

Managing risk collaboratively

Mental health services operate within constantly changing operational environments. Commissioners expect providers to escalate significant concerns promptly so that risks can be managed at system level.

Examples include:

• Persistent workforce shortages.
• Capacity constraints.
• Increased crisis demand.
• Safeguarding concerns.
• Financial pressures affecting delivery.
• Emerging quality risks.

Early escalation allows ICBs to coordinate wider system responses before issues become critical.

Contributing to system transformation

ICBs increasingly involve providers in the design and implementation of new service models. Organisations that contribute positively to transformation programmes often strengthen their strategic relationships with commissioners.

Examples include:

• Testing innovative care pathways.
• Supporting digital transformation.
• Developing integrated community models.
• Participating in workforce initiatives.
• Sharing best practice.
• Evaluating pilot programmes.

Providers that engage constructively with transformation demonstrate leadership beyond contractual delivery.

Operational example 3: improving access through partnership working

An ICB identifies variation in referral processing across several community providers. Working collaboratively, organisations agree a shared improvement programme.

Actions include:

• Standardising referral criteria.
• Improving communication pathways.
• Reviewing operational workflows.
• Sharing learning across organisations.
• Monitoring access performance.
• Reporting improvements through partnership boards.

This coordinated approach improves patient experience while strengthening confidence across the Integrated Care System.

Commissioner expectations

Commissioners increasingly expect providers working with ICBs to demonstrate:

• Strategic partnership working.
• Transparent communication.
• Reliable performance reporting.
• Collaborative problem-solving.
• Early risk escalation.
• Contribution to transformation programmes.
• Strong governance arrangements.
• Continuous improvement and learning.

Common pitfalls to avoid

• Viewing the ICB solely as a contract manager.
• Delaying escalation of operational concerns.
• Poor communication during periods of pressure.
• Providing data without meaningful analysis.
• Limited participation in system initiatives.
• Reactive rather than proactive engagement.
• Working in organisational isolation.
• Failing to align services with wider system priorities.

How to evidence this in tenders and commissioner reviews

Strong tender submissions demonstrate mature relationships with ICBs through practical examples of collaborative leadership, performance reporting, quality improvement, transformation programme participation, risk management, governance and system-wide partnership working. Providers should clearly explain how engagement with ICBs has strengthened pathways, improved outcomes, supported operational resilience or contributed to wider Integrated Care System objectives.

Commissioners increasingly value organisations that consistently demonstrate strategic partnership behaviours while maintaining high-quality operational delivery.

Conclusion

Working effectively with Integrated Care Boards requires providers to move beyond contract compliance towards genuine system leadership. Open communication, transparent performance management and collaborative problem-solving strengthen relationships while improving outcomes for people using mental health services.

Providers that invest in trusted partnerships with ICBs are better positioned to influence future service development, contribute to integrated care transformation and deliver resilient, person-centred mental health services across increasingly complex systems.

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