Back to the Old Order: NHS ICB Leadership Faces a Diversity Reckoning

The reshaping of England’s Integrated Care Boards was meant to usher in a new era of collaboration and community-led leadership. Instead, the latest appointments have exposed a familiar fault line. Of the 26 ICB chief executives now confirmed across standalone and clustered organisations, every one is white, and the vast majority are men.

The figures represent not just a lack of progress, but a regression. Compared with earlier phases of ICB formation, the proportion of women has declined, and there is now no ethnic minority representation among ICB leaders. It is a striking outcome for a system that has publicly committed to inclusion, equality, and representation that mirrors the diverse communities it serves.

Jabeer Butt, chief executive of the Race Equality Foundation, was unequivocal in his assessment, warning that the reorganisation has “rolled back” progress on diversity in senior NHS leadership. His words echo a wider unease: that beneath the rhetoric of integrated care lies a leadership culture still shaped by old networks and familiar faces.

The departure of Patricia Miller, the former Dorset ICB chief executive and the only ethnic minority leader in the previous cohort, underscored this reality. In a message marking her exit, she reflected proudly on nearly four decades in public service, yet lamented that “little progress” had been made on race and health inequalities; the very issues integration was designed to tackle.

This leadership imbalance matters not only symbolically, but practically. Integrated care depends on trust, local insight, and cultural understanding: qualities that are strengthened by diversity of background and experience. When leadership teams do not reflect the populations they serve, they risk designing systems that fail to see or meet the needs of those most marginalised.

The latest appointments suggest that the NHS’s leadership pipeline remains narrow, with few recruits drawn from outside traditional public-sector pathways. As a result, the promise of ICBs, to bridge health and social care, to engage communities, and to reduce inequality, risks being undermined before it begins.

In the end, the composition of leadership is more than an HR statistic. It is a mirror of values, a signal of priorities, and a test of whether the NHS’s commitment to equity will extend beyond words. On that test, at least for now, the picture looks disappointingly familiar.