There had been a palpable sense of growing alarm at the lack of detail on Government plans following the directive for ICBs to cut costs by 50% this year. 

While the scale of cuts remains daunting for a system already stretched to the limit, at least there is a clear timetable and some sense of direction to work with. 

Nonetheless, ICB leaders have warned it remains a tall order to carry out sweeping cuts while at the same time being asked to deliver improved performance. 

While Sir Jim has signalled ICBs will be central to Government reforms, leaders have warned they will require significant support in order to deliver on this mission. 

Detail remains lacking on what form restructured ICBs will take going forward with Sir Jim having hinted at a significant consolidation and speculation rife that the number of ICBs could be halved. 

In his letter to leaders, Sir Jim highlighted the importance of swift action on restructuring in order to retain talent. Given the increasing amount of ICB chiefs resigning in recent months, ongoing uncertainty and tough measures pose a real risk of this exodus accelerating. 

All eyes will be on further announcements expected in the coming days and weeks.