We are concerned that the Department for Health and Social Care and NHS England are still announcing major reforms without either delivery plans or secured funding. We do not accept that it is prudent to make a major change, such as the structural changes that are being made to Integrated Care Boards (ICBs) and NHS England without ensuring there is funding in place to pay for the changes, and without conducting an impact assessment or taking other steps to safeguard value for money. These changes, especially the planned cuts to ICBs, could have a significant negative impact on patients and on the healthcare workforce through the level of uncertainty they create, and because they may limit the ability of NHS organisations to plan for the future. We are concerned that these poor practices, previously seen with the New Hospitals Programme and the High Speed 2 programme are being replicated here and will lead to wasted effort. recommendation The Department should • confirm to us that it will not announce unfunded commitments; • set out the likely costs, with associated funding, together with an impact assessment, for the ICB redundancies and the absorption of NHS England; and • set out how organisational changes at local level relate to, and are properly linked with, other partner organisations such as local authorities. 5 1 Progress in reducing waiting lists for elective care Introduction