Doing more with less: the challenge for ICBs – and the opportunity for innovation that sticks 

While the language may be measured – “savings”, “consolidation”, “reset” – the implications are anything but soft.   The ask – from Jim MacKay’s recent letter – is to cut running costs by 50% by October 2025. The inevitable result is that services are being pared back. Innovation budgets are being squeezed.  

Organisations up and down the country are trying to protect transformation plans while urgently rethinking what they can afford to deliver. 

It’s not surprising. But it is significant. 

At Future Care Capital, we’re not naïve about the scale of the challenge – and we’re not here to pretend the solution lies in clever messaging or the next digital silver bullet. We know these are tough, straightened times and that the decisions being made now will shape what’s possible for years to come. 

So, what is our role in all this? 

First and foremost, we are a charity, allowing us to be both independent and pragmatic.

Secondly, we think our role is to be the glue and the oil – helping make innovation stick and helping the system move. Even when the engine is under pressure. 

What’s happening? 

As The King’s Fund rightly points out, ICBs were only formally established in 2022, after years of policy ambition around integration, collaboration and system working. Now, just two years later, many are facing real-terms funding cuts of up to 10%, with the expectation of “resetting” transformation ambitions in line with national and local financial pressures. 

This isn’t just about headcount. It’s about capacity – to innovate, to collaborate, and to think strategically beyond the day-to-day firefight. If ICBs are forced to retreat into core delivery, we risk losing the very structures that were designed to think across boundaries and shape the future. 

It also puts an even greater burden on local leaders, frontline teams and innovators to keep pushing forward, with fewer resources and less space to experiment. 

Innovation isn’t cancelled – but it needs help 

What we’re hearing from the sector is not a rejection of innovation. Far from it. The appetite for transformation is still there – especially where people can see the impact on patients, professionals and system flow. 

But innovation needs more than intention. It needs support to land, scale and integrate – and that support is what’s most at risk in a squeezed system. 

Take digital innovation. We know it can improve outcomes, reduce pressure and increase flexibility. But without the time and infrastructure to deploy it well – to train teams, align processes and evaluate properly – it can feel like another burden rather than a benefit. 

Or take discharge – a persistent challenge that spans NHS and social care boundaries. We don’t need more pilot projects. We need better alignment, stronger partnerships and clearer pathways to make the improvements stick. 

That’s where organisations like FCC come in. 

What we’re committed to 

Our role is not to tell systems what to do but to help make what’s needed doable. We offer strategic, practical support that helps organisations move ideas from plan to practice, even in difficult contexts. 

We stay focused on three things: 

• Enabling innovation where it will have real, measurable impact 

• Making collaboration work – across systems, sectors and organisational boundaries 

• Providing independent, expert insight to support action in complex environments 

We help leaders make the case, find the gaps, and get traction. Whether that’s building logic models, managing stakeholder alignment, or supporting new approaches to flow, workforce or funding – we are here to help things work better. 

Looking ahead 

We know the next few years won’t be easy. But transformation isn’t something the system can afford to abandon. It just has to look different. Leaner. Smarter. Better supported. 

That’s why FCC will continue to be a constructive partner in innovation and improvement – particularly in places where the pressure is high and the stakes are real. 

We’re not chasing shiny tech or quick wins. We’re here for the long haul – helping health and care systems hold the line, build capacity, and deliver the kind of change that actually sticks.