The Health Overview and Scrutiny Panel met to discuss the progress of the independent review into children's and young people's mental health services and the implications of the NHS Modernisation Bill on the Integrated Care Board (ICB) structure. Significant progress has been made in improving mental health services for young people, including a reduction in waiting times, while the NHS Modernisation Bill has led to structural changes within the ICB, with a focus on strategic commissioning and reduced running costs.

Independent Review of Children's and Young People's Mental Health Services

The panel received a comprehensive update on the independent review of children's and young people's mental health services, which began in December 2023. The review identified five key recommendations: the implementation of a new core delivery model with a lead provider, a shared place-based vision informed by the iThrive framework, clearer governance and accountability, a more flexible model of care, and a redesigned neurodevelopmental pathway.

Since November 2025, responsibility for neurodevelopmental assessment services and Tier 2 getting help therapy services has transferred from Achieving for Children to the NHS Trust, South West London, St George's. This transition involved integrating approximately 11 whole-time equivalent staff into existing services at Richmond Royal and Tolworth Hospital. Efforts have been focused on stabilising services, reviewing waiting lists, managing clinical risk, and aligning with new systems and processes.

Referrals for neurodevelopmental assessments have seen a dramatic increase, from 47 in 2018-19 to an projected 1,319 in 2025-26, making up a significant proportion of referrals to Child and Adolescent Mental Health Services (CAMHS). In Kingston, there were 547 referrals awaiting assessment, with waits of up to two and a half years. To address this backlog, a third-party provider was commissioned, completing nearly 200 assessments to date.

For getting help services (Tier 2), approximately 315 children and young people were waiting for support in Kingston at the time of transfer, with some waits of two to three years. Since November 2025, referrals to these services have increased, but the number of children and young people waiting for treatment has reduced by around 40%, now standing at 145.

Partnership working has been a key focus, with regular pathway interface meetings and a memorandum of understanding with Achieving for Children. The iThrive framework, a needs-led, person-centred approach, is being implemented, with a self-assessment tool highlighting strengths and opportunities for improvement. A pilot one-stop shop in Sutton for children and young people with neurodevelopmental needs is being evaluated for potential rollout in Kingston. A signposting campaign has also been launched to improve awareness of available mental health support options.

Councillor Roger Hayes raised concerns about the increasing complexity of referrals alongside the rise in numbers, which was acknowledged. The panel was assured that while resources are a challenge, there is a strong emphasis on partnership working across health, social care, and education. Councillor Brian Austin questioned the reduction in waiting list numbers, and it was clarified that this included those who had been contacted and confirmed their ongoing need, with options for online therapy also offered. David Still highlighted the potential for young carers to experience burnout and escalate to Tier 3 services if waiting lists remain long, a concern echoed by Councillor Rizwana Malek regarding support for families during waiting times. The panel was informed about while-you-wait packs, psychoeducation groups, and duty clinician availability.

NHS Modernisation Bill and ICB Structure Changes

The panel was informed about the changes to the Integrated Care Board (ICB) structure resulting from the NHS Modernisation Bill. It was clarified that NHS South West London (SWL) and NHS South East London (SEL) ICBs have not merged but have established joint executive leadership and shared functions to reduce duplication and strengthen resilience. Kingston remains within NHS SWL ICB.

The national policy requires ICBs to reduce running costs, leading to a smaller ICB workforce and changes in how some commissioning and local support functions are organised. Across SWL, central commissioning and contracting teams have reduced by approximately 50-58%, and local Place-based team capacity has reduced by 75%. While no acute or community services for Kingston residents have been reduced or cut, there are potential impacts on capacity, local knowledge, and the speed of addressing issues during the transition.

Concerns were raised regarding the impact on safeguarding oversight. Elaine Clancy, Chief Nurse and Quality Officer for SWL ICB, confirmed that the Deputy Chief Nurse would hold responsibility for safeguarding strategy and operational oversight across all boroughs, with separate arrangements for Kingston (Adults) and Kingston and Richmond (Children). It was assured that specialisms would be retained and that partnership arrangements for safeguarding oversight remain separate.

Councillor Peter Higgins questioned the combined role for safeguarding and was assured that the Kingston Adults Board and the Kingston and Richmond Children's Partnership remain separate statutory entities. Ian Duds, Director of Children's Services, confirmed that separate designated safeguarding nurses for adults and children are in place, with the children's post covering both Kingston and Richmond.

The impact of these changes on continuing healthcare packages was discussed, with the Royal Borough of Kingston reporting that a significant number of packages had been reduced or removed due to a move towards standardisation. This has necessitated an increased funding contribution from the local authority. Fergus Keegan, Deputy Chief Nurse for SWL ICB, explained that the transformation of continuing care began three years ago to address inconsistencies in assessments and costs, aiming for a national framework application. This has led to adjustments in awards, with some individuals receiving less NHS funding and others more, and has also impacted social care funding arrangements.

Concerns were also raised by directors of public health across SWL regarding the new staffing model for community infection and control. Laura McLehose, Consultant in Public Health, noted that a response from the ICB was included in the pack and that public health teams are working closely with the ICB on neighbourhood developments and reducing health inequalities.

The panel also discussed the impact on general practice, with the Kingston GP Chambers acknowledging that while clinical services are not expected to be affected, there may be impacts on contracting timelines and administrative services due to changes in the local primary care team and the South West London ICB Primary Care Team.

Kingston Voluntary Action (KVA) reported that their services have not been directly affected yet, but the ongoing restructuring in health has influenced their strategy. Healthwatch Kingston noted a reduction in partnership capacity due to the cessation of SWL ICB funding for joint work, impacting independent insight gathering.

Your Healthcare stated that while local services have continued to operate effectively, the larger structure has made securing timely commissioner input more challenging. They have strengthened their focus on place-based leadership and partnership working to address these challenges.

The meeting concluded with Councillor Helen Grocott, Chair of the Health Overview and Scrutiny Panel, thanking attendees for their time.