ICBs and providers are to be graded from 1-5 on level of delivery under new draft guidance issued by NHSE.

The NHS Performance Assessment Framework for 2025/26 will see ICBs and providers graded from 1 (high performing) to 4 (poorly performing) with an additional segment 5 to indicate the most intensive support requirement.

Each grading will determine the level of support and improvement required and whether intervention is necessary.

NHSE said measures should increasingly focus on outcomes and effectiveness alongside access and value for money.

The aim of the grading system is to ensure high performing organisations in segment 1 will receive greater autonomy, while organisations in segments 3 and 4 will be considered for further support and interventions which may include enforcement activity.

Organisations with a segment of 4 will receive a diagnostic review, and this will determine whether they will enter segment 5 and receive support under the Recovery Support Programme for the most challenged organisations.

As part of the assessment process, leadership capability in ICBs and providers will also be assessed.

Reaction

Interim chief executive of NHS Providers, Saffron Cordery said: ‘We welcome the clarity of this new approach, lessening the burden on trusts and avoiding duplication.  

‘NHS trusts leaders are all for being accountable and are committed to working with partners to create a regulatory system which has the confidence of everyone involved.'

Sarah Walter, director of the NHS Confederation's Integrated Care Systems Network, said: ‘We understand the short-term need to get a financial "grip", but we have concerns that this new approach is too individualistic. ICBs are to be held accountable for all the organisations in their system while providers are not held to account for the part they have to play in system performance. This calls into question the ability of systems to achieve the three shifts.'