Integrated Care Boards (ICB’s) were created from the old Clinical Commissioning Groups who were created from the old Primary Care Trusts, with the latter being seen to be delivering services.
The change in responsibilities mean that over time the role has moved from doing to more directing, which means that when it comes to business decisions there is a gap on the ground about what those decisions mean in practice.
It is a just further refinement from the silly decision to create Commissioning Support Units (CSU) of which there are only about five left.
You cannot separate the “doers” from the “deciders”.
I think that ICB’s as a concept (do not get me onto ICS’s) will go sooner rather than later as there becomes a focus on NHS organisations being clearly operational – doers.