Sally Lee, Programme Manager, Improving Population Health, NHS West Yorkshire Integrated Care Board, writes:
Right now, across England, Integrated Care Boards are going through significant changes—reductions in running costs, shifts in purpose, and questions about their future role. These changes might sound technical or organisational, but they are not abstract. They ripple outwards and shape the way we look after our population, support our workforce, and deliver services on the ground. When I reflect on my own recent experience of the NHS as a family member, I am reminded that these decisions are not just about structures—they are about people. They determine whether we have the capacity, the culture, and the connections to provide the kind of care that is not only clinically effective but also compassionate and trauma-informed.
Why trauma-informed care and strong integrated care boards matter
RecentIy I found myself in a place I never imagined—sitting in A&E not as a programme manager, but as a wife supporting my husband through a frightening health emergency.
We attended because of the sudden onset of severe abdominal pain that left him distressed and fearful. As someone who has worked in the NHS for 17 years, I know the pressure our colleagues face on the frontline. I understand the daily reality of staff shortages, overwhelming demand, and the strain of delivering care in an overstretched system. But what struck me was not the waiting times, or the busyness of the department—it was the way we were made to feel.
At a time when compassion and reassurance mattered most, they were absent. My husband, already in pain, was left feeling judged and dismissed, rather than cared for and supported. For me, this was not simply about one encounter—it was a reminder of what happens when trauma-informed approaches are not embedded across our system.
Trauma-Informed Care is Not Optional
Trauma-informed care is not an “add-on” or a “nice to have.” It is about recognising that every patient carries experiences, fears, and vulnerabilities into the consultation room. A kind word, an acknowledgement, or simply being listened to can change the trajectory of someone’s experience entirely. The outcome for my husband could have been so different if compassion and understanding had been at the centre of the interaction.
This is why I am so concerned when I hear discussions about reducing investment in trauma-informed training and culture change. Without it, patients leave feeling unseen and unsupported. We must not underestimate the long-term damage this does—to patient trust, to health outcomes, and to the reputation of our NHS.
The Role of Integrated Care Boards
As we talk about restructuring Integrated Care Boards (ICBs), reducing staff, and narrowing their purpose, I fear we are heading in the wrong direction. ICBs were created to bring organisations together, to break down silos, and to ensure that health, social care, voluntary, and community partners could work in a genuinely integrated way. This collaboration is vital to addressing the root causes of poor health and reducing the demand on urgent and emergency care.
Stripping back the role of ICBs and cutting capacity will not fix waiting times. It will not address the workforce crisis. It will not reduce health inequalities. In fact, it risks undoing the progress we have made by shifting the focus back onto short-term, transactional targets rather than long-term transformation.
ICBs play a crucial role in developing and embedding approaches like trauma-informed care. They are the space where innovation can be tested, where communities can have a voice, and where we can build services that respond to the needs of people rather than the constraints of organisations. If we weaken this role, we weaken the system as a whole.
Why This Matters for the NHS
The challenges facing the NHS cannot be solved by centralising decision-making and cutting the very people tasked with joining up care. Waiting times are a symptom of deeper issues—underinvestment in prevention, lack of workforce capacity, and failure to address health inequalities. ICBs are designed to tackle these underlying causes. To reduce their scope now is to put a sticking plaster over a wound that requires urgent and thoughtful treatment.
My husband’s experience in A&E was a painful reminder of why these issues matter. Without trauma-informed, compassionate care, patients leave feeling worse than when they arrived. Without strong, well-resourced ICBs, we lose the ability to create the system-wide change that will make the NHS sustainable for the future.
We should be investing in integration, not dismantling it. We should be valuing trauma-informed care, not treating it as optional. We should be strengthening, not weakening, the very teams who are working to improve outcomes across health and care.
Because at the end of the day, this is not about policy papers or organisational charts—it is about people. People like my husband, who walk through the doors of A&E scared and in pain. People who deserve to feel heard, valued, and cared for. And unless we get this right, we are failing them.
As these changes unfold, we cannot lose sight of what is at stake. The choices we make about the future of ICBs will either strengthen or weaken our collective ability to build an NHS that is sustainable, equitable, and truly person-centred. If we strip back too far, we risk fragmenting the progress made, leaving our workforce overstretched, our communities unheard, and our services reactive rather than preventative. But if we choose to invest in integration, value trauma-informed practice, and protect the spaces where collaboration happens, we can create a system that not only treats illness but also nurtures health and resilience. That is the future our population, our staff, and our services deserve—and it is the future we must fight for.