Hounslow Residents Seek Clarity on West and North London ICB Restructuring
Hounslow residents are seeking greater clarity on the significant restructuring underway within the West and North London Integrated Care Board (ICB), a move intended to enhance strategic commissioning and improve population health outcomes across 13 boroughs and a population of 4.5 million people, with an annual budget of £12 billion.
At a recent Hounslow Health and Wellbeing Board meeting, Katie Coleman, Deputy Chief Medical Officer for the Western North London ICB, outlined the new structure. The ICB is shifting its focus towards strategic commissioning, population health outcomes, and equity, with an ambition to reduce operational costs and lessen reliance on acute hospital care. The ICB aims to reduce operational budgets by 50% by redesigning structures and ways of working, aligning with the national ICB Blueprint. While this reduction target is set, specific projected savings have not been detailed.
Coleman emphasised the ICB's commitment to understanding local population needs, making informed decisions, and utilising commissioning levers to drive consistency and improve outcomes. Key priorities for the first year, which began on April 1st, 2026, include delivering operational commitments and financial plans, establishing the new organisation for success, investing in high-impact population health interventions, and developing a clinically-led strategy. The new structure is expected to be fully in place after the summer, with the strategy anticipated by autumn, followed by a strategic commissioning plan.
Concerns were raised during the meeting regarding the clarity of communication from the ICB to local authorities. Martin Waddington, Director of Integrated Care Partnership and Commissioning, echoed these sentiments, expressing a desire for more concrete details on how these changes will directly benefit Hounslow residents. The ICB plans to ensure ongoing and transparent communication by maintaining representation at local authority meetings, including Health and Wellbeing Boards, where a named Director-level contact will be allocated for each Board. They will also attend Joint Health Overview and Scrutiny Committees (JHOSCs) and Health and Social Care Scrutiny Committees (HASCs) as needed. Coleman stated, I'm here working with Hounslow, and different people will be working with sort of different boroughs.
However, further specific mechanisms for continuous, transparent communication beyond these attendances are not yet detailed.
The ICB's strategy aims to Develop a clinically-led strategy
by understanding population needs through segmentation and analysing variations in outcomes. This will inform a clear plan for changing spending to achieve the greatest impact on outcomes, demand, and costs. Coleman stated, Our focus is to strategically commission healthcare services that improve health and lives of West and North London residents, both now and in the future.
She added, We base strategic commissioning decisions on population need, reduce inequalities, use data and engagement more effectively and direct resources to improve outcomes and value.
The strategy will be developed in collaboration with communities and shaped by resident and patient insights.
The ICB's focus on equity is a core principle, aiming to address the fact that Life chances across West and North London are not equal. There is a 17 year variation in healthy life expectancy across neighbourhoods, with people in our most deprived communities experiencing significantly poorer outcomes.
The strategy seeks to Reduce health gaps between communities
and Focus help on those who need it most.
The ICB plans to Invest the 1% for impact
by prioritising high-impact population health interventions
to learn lessons for the longer-term strategy. This investment is projected to reach £360 million annually by year three, dedicated to prevention and early intervention activities. Effectiveness measurement for these interventions is not detailed beyond the general aim of driving impact.
The shift away from a system heavily reliant on acute hospital care presents challenges. The presentation notes that Most of the £12 billion spent a year on health and care is currently used in hospitals and crisis services. This has been important to manage hospital demand, and short-term pressures, but it is not delivering fair outcomes and is unsustainable.
The ICB acknowledges the need to maintain a grip over the commissioning reality of today while driving the emergence of new commissioning models and provider relationships.
Mitigation strategies include supporting people earlier and closer to home, focusing help on those most in need, and making the best use of money to keep services affordable for the future. The 1% for impact
investment is also intended to support this transition towards prevention and early intervention.
Further details on the ICB's restructuring and its implications can be found in the Public reports pack for the Hounslow Health and Wellbeing Board meeting.