Cheshire & Merseyside ICB (the ICB — the NHS body that plans and funds care for this area · 15+ provider trusts)
2026/27 — the year ahead (the ICB as planner of its area)
£155.4mthe savings this ICB itself must find in 2026/27.2026/27 CRES requirement — raised in-year from £144m; the ICB’s own commissioner budgets, not its providers’ CIPs.
No 2026/27 system workforce plan published — none appears in the public papers we hold. iWhat does a “workforce reduction” mean? Not always people losing their jobs. Boards count in WTE — units of one full-time post — and the routes differ in who they touch. Cutting agency work: paid work lost, but no NHS post existed. Cutting bank shifts: extra shifts mostly worked by the trust’s own staff — a pay cut that never shows in post counts. Freezing vacancies: no one is dismissed, but the post and its future job go, and the work lands on those who remain. Deleting posts shrinks the establishment itself. Voluntary exits: MARS is a paid resignation without redundancy rights; voluntary redundancy is redundancy on volunteered terms. Compulsory redundancy is the rarest route — boards report it separately in their audited accounts.
Two targets, one pot
NHS England hands this area one health budget for the year. The ICB keeps a slice to spend directly — prescribing, care it arranges itself, and its own running costs — and the savings target at the top of this card (£155.4m, for 2026/27) applies to that slice only. The rest — most of the budget — is paid to the trusts for care, and each trust sets its own savings plan on what it receives; those plans are listed below and on the trust cards. Put together in the system plan, the whole area’s savings ask for 2025/26 — the trusts’ programmes and the ICB’s together — was £572.4m. A 2026/27 equivalent has not yet been published — not by the board, and not in NHS England’s central reporting, which so far gives only the first quarter’s savings plans, not the year’s.iAre the two targets connected? Through the money, yes: most of what the ICB spends is payments to its trusts, so when the ICB saves on the care it buys, part of that saving can arrive at a trust as lower income. But not all ICB savings touch the trusts — savings on prescribing or the ICB’s own running costs don’t. The papers don’t break down how much of each, so the two figures are shown separately and we never add them.
Its trusts’ plans
Of the ICB’s 16 provider trusts, 10 have published a 2026/27 workforce-reduction figure: Alder Hey Children's −265 WTE; Cheshire & Wirral Partnership −150 WTE; The Clatterbridge Cancer Centre; Liverpool Heart & Chest −60 WTE; Liverpool University Hospitals −826 WTE; Liverpool Women's −76 WTE; Mid Cheshire Hospitals −370 WTE; Wirral Community Health & Care 64 WTE; Wirral University Teaching Hospital 305 WTE; NC&M (was Warrington & Halton) −118 WTE. 1 states a reduction without publishing a number: The Walton Centre. iHow to read these counts. Every count is a minimum — it counts only what the public papers show; the true number can only be higher. We do not add the figures into one total: they sit on different bases (gross next to net, minimums, cost targets expressed as posts), so any sum would be our number, not the boards’. A cut targeted at bank or temporary staffing still hits staff’s work and pay, but never appears in post counts. Each trust’s card carries its own caveats.
Last year
In 2025/26, 12 of the ICB’s 16 trusts finished the year over their workforce plans — together 2,559.7 WTE and £94.8m over plan at year end. On the national payroll count, 281 clinical support posts (healthcare assistants, nursing assistants and therapy assistants) were lost across the trusts the count covers (12 of 16) — a minimum.
Its own organisation
The ICB is also an employer, under national instruction to cut its own running costs: its board has adopted the national target of £19 per head of population (the “Model ICB” blueprint). National payroll figures — the same count used on the trust cards — show the ICB’s own staff fell from 1,015 to 902 WTE between April 2025 and April 2026 (-113, -11.1%).
Risks it carries
The ICB’s own risk register scores
6 risks at 15 or more out of 25 — the range we mark as very high or extreme. The highest of them:
- “Quality and safety failures in commissioned services” — 20 of 25 — risk to quality and safety of care
- “Failure to meet national performance / access standards” — 20 of 25 — pressure on waiting times, access and capacity
- “Inability to achieve financial sustainability and productivity” — 20 of 25 — financial pressure
Where the financial pressure comes from
The board itself names what is driving its financial pressure: short-term support that helps people regain independence at home (reablement); budgets shared with local councils; individually arranged mental-health care packages; and the medicines bill (prescribing). iThese are the cost pressures the ICB itself names on its budget. Wider pressures — on services, waiting times or safety — appear under “Risks it carries”, from the board’s own risk register. C&M system-side drivers, board-stated: at month 3 the system is £7m adverse to plan; three providers report adverse variances largely driven by the impact of Industrial Action and non-delivery of Cost Improvement Plans (CIP); committee echo names the same two drivers for providers' early deficits. C&M board-stated funding gap on workforce cuts: workforce reduction plans across the system are likely to require non-recurrent funding for implementation, which has not currently been identified — the system says its workforce cuts need one-off money it has not yet found.
On the record — the ICB’s own papers & where every figure comes from
- NHS C&M ICB running-cost target — £19 per head (Model ICB Blueprint) C&M ICB Board — 28 May 2026 · p.166
- C&M ICB pressure drivers, board-stated: pressures in community reablement, pooled budgets and mental health packages (unclear drivers partly due to delays in local authority reporting); mental-health packages of care overspend driven by rising patient numbers and higher spend on inpatient care and Mental Health Act placements; prescribing items and cost per dispensing day both up 3% on last year. C&M ICB Board 30 Jul 2026 — board meeting pack (M3 finance report + FICC report)
- C&M system-side drivers, board-stated: at month 3 the system is £7m adverse to plan; three providers report adverse variances largely driven by the impact of Industrial Action and non-delivery of Cost Improvement Plans (CIP); committee echo names the same two drivers for providers' early deficits. C&M ICB Board 30 Jul 2026 — board meeting pack (M3 finance report + FICC report)
- C&M board-stated funding gap on workforce cuts: workforce reduction plans across the system are likely to require non-recurrent funding for implementation, which has not currently been identified — the system says its workforce cuts need one-off money it has not yet found. C&M ICB Board 30 Jul 2026 — board meeting pack (M3 finance report + FICC report)
Sources: the ICB’s own board papers (cited above) · every figure is traceable to the evidence ledger on the audit twin of this page
Plain-English key
WTE / FTEtwo names for the same measure — one full-time post’s worth of paid staff time (two half-time staff count as one). It is a unit of time, not a count of people: a reduction of 100 WTE can mean fewer people, fewer hours, or fewer bank and agency shifts, and is usually a mix. Boards plan and report in WTE across all staff — permanent, bank and agency together — and so does this card, which says which of those a figure counts. Boards write WTE (“whole-time equivalent”); the national statistics write FTE (“full-time equivalent”).
CIP“cost improvement programme” — the NHS term for a savings plan.
Deficitspending more than the money coming in. A trust whose plan is a deficit is planning to end the year in the red by that amount.
MARS“mutually agreed resignation scheme” — a voluntary paid-exit scheme.
Establishmentthe number of funded posts a trust plans to employ — its budgeted staffing level — whether or not each post is filled. Removing a vacancy from the establishment cuts the planned staffing level without anyone losing a job.
ICB“integrated care board” — the NHS body that plans and funds care for an area.
Running coststhe ICB’s own organisation — its staff and administration — which national policy requires it to cut to a set amount per head of population.