How an ICB Reaches a Decision in 2026

Introduction

When the NHS reorganised itself in 2022, it did something that changed the shape of a great many sales without changing the sales pitch most suppliers still use. Clinical commissioning groups were closed and forty-two integrated care systems were put on a statutory footing, each with an integrated care board responsible for planning and paying for care across a whole population [1][2]. A supplier who learned to sell to the NHS before that shift, or who learned the NHS from the outside afterwards, often still pictures a buyer who does not exist: a single decision-maker with a budget and a signature. The integrated care board is not that, and understanding what it is instead is most of the work of selling to one.

I have watched suppliers pitch an ICB as though it were a large hospital with a bigger budget. It is a different kind of body making a different kind of decision, and the pitch that lands with a trust can miss an ICB entirely — not because it is weaker, but because it answers the wrong buyer's question.

An ICB buys for a population, not a building

A hospital trust buys largely for itself — its wards, its clinicians, its patients, its budget. An integrated care board plans and funds care across a whole area, bringing together the NHS, local authorities and other partners to improve health for a defined population [1][2]. That difference reshapes the decision. A trust can ask 'is this good for us?'. An ICB has to ask 'is this good for the…