Helping the Thames Valley ICB spend £5.6 billion more wisely

The NHS in the Thames Valley serves 2.5 million people and spends £5.6 billion a year. But how do the leaders responsible for that budget decide which services to fund, which to scale back, and which to redesign?

That question has become urgent. Integrated Care Boards are being asked to do more with less – acting as "strategic commissioners" who use data and evidence to allocate resources, all while managing shrinking teams. In early 2026, the picture became more complicated still: ICB borders were redrawn across England, meaning leaders in the new Thames Valley ICB inherited a patchwork of services, contracts, and population needs they had never previously overseen together.

They needed new tools. Not just dashboards and datasets, but a structured way to define what "value" means in health care – and to use that definition to make fair, transparent commissioning decisions.

Our approach and partners

Researchers at the University of Oxford are working directly with senior leaders from the former Buckinghamshire, Oxfordshire and Berkshire West ICB and Frimley ICB – now part of the Thames Valley ICB – to build that capability from the ground up. The work also involves NHS provider organisations, community and social care partners, and patient groups.

The programme has four phases. First, the team used qualitative research and discrete choice experiments to identify what matters most when assessing value – drawing on the perspectives of ICB leaders, clinicians, community organisations, and patients. Second, a systematic review (led by a DPhil student) is cataloguing how value can be measured in routine NHS data and how contracts can be designed to reflect it. Third, economic and statistical modelling will identify the most robust indicators for each element of value. Finally, the team will help the ICB design, launch, and evaluate value-based contracts in practice.

What we found – and why it matters

1. Six elements of value identified. Discrete choice experiments revealed six primary dimensions that stakeholders – from ICB executives to patient representatives – consider most important when judging the worth of health services. These provide a shared language for commissioning decisions.
2. Multi-criteria decision analysis works for NHS commissioning. The team demonstrated that structured algorithmic approaches can feasibly support real-world decisions about which services to fund, continue, or decommission – moving beyond gut instinct and historical precedent.
3. Research is already shaping ICB strategy. Findings fed directly into the Thames Valley ICB's Commissioning Intentions 2026–2030, influencing how the board sets priorities and allocates resources over the next five years.
4. Pilot value-based contracts are launching. ARC researchers helped design the evaluation framework for the Thames Valley ICB Innovation Fund. New pilot contracts for organisation-led programmes are expected to launch in April 2026.

The programme will ultimately deliver a comprehensive decision support framework for ICB staff and establish a permanent Value Lab within the ICB – embedding long-term analytic capacity rather than relying on one-off research projects.

What this means

If this approach works as intended, commissioning decisions across the Thames Valley will be driven by evidence of what delivers genuine value for patients – not simply by what was funded last year. For 2.5 million people, that means a health system better equipped to direct resources where they matter most: towards services that improve health, reduce waste, and address inequalities. The ambition extends beyond one region. The tools and frameworks being developed are designed to be transferable, offering a model that other ICBs across England could adopt.

What needs to happen next

This work is still in its early stages. The discrete choice experiments and feasibility testing are complete, but the systematic review, modelling, contract design, and evaluation all lie ahead. Continued close partnership between the research team and ICB leadership is essential – without it, neither the research findings nor their translation into practice can be fully realised. The upcoming ICB boundary changes make that partnership both more difficult and more important.