The North Central London Joint Health Overview and Scrutiny Committee (JHOSC) met to discuss mental health pathways in North Central London, and to outline the work programme for the coming year. The meeting was scheduled to include an update on mental health services, focusing on transitions from children's to adult services and information sharing between organisations. The Public reports pack also included the proposed work programme for 2025-26.

Mental Health Pathways

A report was prepared to update the JHOSC on mental health pathways in North Central London (NCL). The update focused on:

• Improving transitions from children and young people’s (CYP) services to adult mental health services
• Strengthening how information is shared across organisations

The report stated that the services are designed to support people with a wide range of mental health needs, from mild to complex and severe.

Since 2022, steps have been taken to reduce variation in services between boroughs, with a Core Offer for Mental Health Services being implemented across a multi-year programme. Significant investment has been made to address historical gaps, particularly in Barnet, Enfield and Haringey, where levels of variation have been higher.

The report stated that crisis services are available 24 hours a day, 7 days a week, through phone lines, walk-in Crisis Cafés, home treatment teams, and emergency support via the Mental Health Crisis Assessment Service (MHCAS). For those needing longer-term care, Community Mental Health Teams provide personalised support for mental, physical, and social needs, including therapy, medication, and help with housing and employment.

Adult Mental Health Services

The Mental Health Core Offer for Working Age Adults was developed to address inequity in service provision and improve the standardisation of services. Since the start of the programme, approximately £50 million has been invested to meet growing needs and reduce variation, with a large proportion directed towards services in Barnet, Enfield and Haringey to address historical funding gaps.

The report outlined a range of mental health services in NCL to support people with differing levels of need:

• Early intervention and prevention
• Mild or moderate to complex
• Complex to severe

The report also detailed the Single Point of Access for Core Community Teams that is in development.

Children and Young People's Services

North Central London has a population of approximately 1.7 million residents, of which 323,000 are under 18 years of age. Each borough has multiple NHS providers and services operating as a result of the five legacy CCGs commissioning in isolation. Due to these legacy arrangements, no borough has a single provider of CAMHS¹.

Community CAMHS provision from NHS providers includes:

• Access teams and general Children and Adolescent Mental Health Services (CAMHS)
• Provision in schools, including Mental Health Support Teams (MHST) across 45% of schools and provision within Pupil Referral Units
• Services for assessment and treatment of neurodevelopmental needs, including Autism and ADHD
• Specialist provision for young adults and adolescents
• Specialist support for Looked After Children
• Provision within Youth Offending Services (YOS) and police custody
• Support for those with eating disorders
• Crisis provision
• Inpatient and outpatient support for children and young people under the care of acute providers

Transitions for Young People Aged 18–25

The report recognised that turning 18 can feel like a cliff edge for young people leaving CYP mental health services, and that without appropriate adult services, some fall through the cracks. It stated that continuity and developmentally appropriate support are critical, and that transitions are life-changing processes.

The challenges for 18-25 year olds include:

• Inconsistent service availability
• Disruption to therapeutic relationships
• Repetition of story due to poor information sharing
• Lack of tailored adult services (ASD, ADHD, emotional needs)
• Gaps for those not meeting adult mental health service thresholds (missing middle )
• Variable planning and engagement

To address these challenges, the report outlined what is already in place, improvements being worked on, and what's next.

What is already in place:

• A clear plan to support young people moving from children’s to adult mental health services, based on national guidance.
• Planning begins at age 17½ so there’s time to get things right.
• Special teams focused on 18–25 year olds in both children's and adult mental health services.
• Extra help for young people with additional needs or disabilities.
• Joint planning meetings that focus on each young person’s needs.
• Handovers are done gradually—with support—not suddenly or without preparation.

Improvements being worked on:

• One single transition team for all five boroughs.
• Training for staff that’s co-designed with young people and families.
• Getting different services to work more closely together via the CYP provider collaborative.
• Setting shared standards across all boroughs.
• Making the move into adult services smoother and more consistent.
• Coordinating services better across the whole system.
• Making sure support is based on what someone needs, not just their age.

What’s next:

• Keeping young people involved in shaping services and giving feedback.
• Creating flexible, person-centred plans through the CYP collaborative
• Providing clear and simple information for young people and families.

The report included a case study of a young person named Kwame, who has been supported by CAMHS since he was 14.

Information Sharing

The report stated that good communication between services means people get better care, and that when professionals can easily share important information, it helps with quicker decisions, smoother care, and better health outcomes—especially when multiple services are involved.

The report referenced the Triangle of Care, developed by the Carers Trust, which aims to foster collaboration in mental health care by involving carers, service users, and health professionals.

There are several initiatives in place to enable better sharing of information across organisations digitally:

• London Care Record (LCR)
• GP Connect and MESH
• Patient Knows Best (PKB)
• NHS Wayfinder Services
• Blood test results integration

The report also detailed improvements for 2025/26 and beyond, including the North London Foundation Trust (NLFT) adult community single point of access (SPA). The plan is to establish this in Barnet by June 2025, with lessons learned from the Barnet implementation being incorporated into the extension of the service to the remaining five boroughs by March 2026.

NCL’s Neighbourhood Model

The report stated that the NCL is working to translate and act on 2025/26 national guidance on neighbourhood health. Core components of an effective neighbourhood services include:

1. Community-Based Care: Shift services from hospital to community
2. Preventative Measures: Implement early intervention programs
3. Digital Integration: Utilise digital tools and infrastructure to enhance care delivery

The vision for neighbourhoods in NCL includes:

• Ring-fenced time to focus on prevention, early intervention and proactive care
• Teams that know each other and know local resources
• A leadership team made up of statutory services across housing, employment, public health, community care, primary care, and nominated VCSE
• Neighbourhood Manager to facilitate and coordinate
• Able to deploy range of case management/care coordination/health navigators
• Act as a place to problem solve, unblock or take additional action
• Able to connect with the Borough Partnership to discuss gaps or strategic need
• Links to local services to coordinate action
• Insightful integrated data linked to each of the pillars which can be seen in aggregate to understand trends and at individual level to build targeted lists; risk stratified and segmented
• Coordinated specialist input to reduce duplication and provide streamlined support (eg geriatrician, LTC consultant)
• A growing network of traditional sites moving toward becoming holistic, MECC-focussed neighbourhood hubs focussed on proactive care and early intervention

Work Programme 2025-2026

The Public reports pack included a report outlining the possible areas that the Committee could focus on for the 2025-26 work programme. The next meeting of the JHOSC is scheduled to take place on 7 July 2025.

In considering suitable topics for the JHOSC, the Committee was asked to have regard to its Terms of Reference:

• “To engage with relevant NHS bodies on strategic area wide issues in respect of the co-ordination, commissioning and provision of NHS health services across the whole of the area of Barnet, Camden, Enfield, Haringey and Islington;
• To respond, where appropriate, to any proposals for change to specialised NHS services that are commissioned on a cross-borough basis and where there are comparatively small numbers of patients in each of the participating boroughs;
• To respond to any formal consultations on proposals for substantial developments or variations in health services across affecting the areas of Barnet, Camden, Enfield, Haringey and Islington and to decide whether to use the power of referral to the Secretary of State for Health on behalf of Councils who have formally agreed to delegate this power to it when responding to formal consultations involving all the five boroughs participating in the JHOSC;
• The joint committee will work independently of both the Cabinet and health overview and scrutiny committees (HOSCs) of its parent authorities, although evidence collected by individual HOSCs may be submitted as evidence to the joint committee and considered at its discretion;
• The joint committee will seek to promote joint working where it may provide more effective use of health scrutiny and NHS resources and will endeavour to avoid duplicating the work of individual HOSCs. As part of this, the joint committee may establish sub and working groups as appropriate to consider issues of mutual concern provided that this does not duplicate work by individual HOSCs; and
• The joint committee will aim to work together in a spirit of co-operation, striving to work to a consensual view to the benefit of local people.”

The work programme for 2025/26 was listed as vacant, but the report included a list of standing items that the Committee usually schedules each year and also a list of as yet unscheduled items on which the Committee has previously indicated that it wishes to receive further updates.

Usual standing items each year:

• Estates Strategy Update
• Workforce Update
• Finance Update
• Winter Planning Update

Possible items for inclusion in future meetings:

• Terms of Reference – revised version for JHOSC ToR to be discussed/approved by Committee.
• St Pancras Hospital update – Expected to be scheduled in 2025/26.
• Health Inequalities Fund – Last item heard in Feb 2025.
• NMUH/Royal Free merger – Last item heard in Sep 2024.
• Smoking cessation & vaping.
• The efficacy of online GP consultations.
• Developing technology and its role in the management of long-term chronic conditions.
• Strategic role of GP Federations.
• Vaccination initiatives tailored to specific local needs in each NCL Borough including outreach work with community pharmacies.
• Paediatric service review.
• Primary care commissioning and the monitoring of private corporations operating in this area.
• Increases in number of people being charged for services that they were previously able to access free of charge through the NHS (e.g. dentistry/ear wax syringing).
• Mental Health & Community/Voluntary Sector – In August 2024, the ICB/Mental Health Trusts provided an update on Community & Voluntary Sector contract terms.