Speaking exclusively to Healthcare Management at the National Children and Adult Social Conference in Bournemouth, McGregor said the 50% cuts being demanded of ICBs this year were having a ‘really big impact on local areas'.

‘The first thing I'd want to say is that there's a huge amount of empathy and compassion towards people who are going through yet another big structural change, with a lot of uncertainty about what's going to be at the other end,' McGregor said.

‘There are lots of very significant areas that we are used to working on together, often areas where we fund things jointly to make things easier and more simplified for people, like continuing health care, Section 117 and funded nursing care, where it's really unclear where those responsibilities now sit.'

McGregor said local authorities were increasingly seeing people they used to work with in these important areas ‘disappearing', adding there was a ‘lack of clarity about where the kind of legal responsibilities the ICBs have to do that will sit'.

The ADASS president said there were some ‘quite significant amounts of money' owed to local authorities by ICBs around the country due to delays and disputes which was adding to financial pressure on local authorities.

On a positive note, she said there were ‘big opportunities' for local government within the reframing of strategic commissioning and ‘how we do that across place together'.

‘There's a real appetite from local government to start to do some work with ICB colleagues on designing what we want strategic commissioning to look like at place, and how can it be integrated,' McGregor said.

‘But I think at the moment, the challenges [ICBs] are going through are so existential that there almost isn't the bandwidth to do that.'