Worries over safeguarding oversight and the impact on continuing healthcare packages have been raised following structural changes within the NHS Integrated Care Board (ICB).
Councillors at Kingston upon Thames' Health Overview and Scrutiny Panel meeting on Thursday, 22 October 2026, heard that while no acute or community services for Kingston residents have been reduced or cut due to the NHS Modernisation Bill, concerns remain about the implications of a restructured ICB.
The panel was informed 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 the SWL ICB. The report states that NHS South West London ICB and NHS South East London ICB have not merged. They remain separate statutory organisations, with their own Boards, legal responsibilities, populations and geographies. They share a Chair, Chief Executive, Executive Team and selected functions where this supports resilience, specialist expertise and the effective use of resources.
The purpose is to work at the right scale for the task: sharing leadership, specialist expertise and learning where this makes both ICBs stronger, while retaining local accountability, decisions rooted in place and strong relationships with borough partners.
The report does not detail specific monitoring mechanisms to ensure accountability and prevent dilution of local decision-making, but emphasises that local accountability, decisions rooted in place and strong relationships with borough partners
are being retained.
However, a significant reduction in ICB running costs has led to a smaller 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 been cut by 75%.
Concerns were voiced regarding the impact on safeguarding oversight. Elaine Clancy, Chief Nurse and Quality Officer for SWL ICB, assured the panel that the Deputy Chief Nurse would retain responsibility for safeguarding strategy and operational oversight across all boroughs, with separate arrangements for Kingston (Adults) and Kingston and Richmond (Children). Ian Duds, Director of Children's Services, further clarified that separate designated safeguarding nurses for adults and children are in place, with the children's post covering both Kingston and Richmond.
He assured that specialisms would be retained and that partnership arrangements for safeguarding oversight remain separate.
The report states that there has been no material change in their capacity because of the consultation
for Designated Doctor roles and Named GP roles. For Designated Nurse and Professional roles, a move to a single post holder for adults and children designate roles covering the boroughs of Kingston and Richmond
has occurred, and Both posts have been recruited to and will provide continuity through their prior local relationships and ways of working.
Councillor Peter Higgins questioned the combined role, but was assured that the Kingston Adults Board and the Kingston and Richmond Children's Partnership remain separate statutory entities.
Further concerns were raised about continuing healthcare packages. The Royal Borough of Kingston reported that a significant number of these packages had been reduced or removed due to a move towards standardisation, necessitating an increased funding contribution from the local authority. Fergus Keegan, Deputy Chief Nurse for SWL ICB, explained that this transformation began three years ago to address inconsistencies in assessments and costs, aiming for a national framework application. The approach in standardising was delivering what is the national framework as opposed to exceeding what the national framework would have allowed us to do.
This has led to adjustments in awards, with some individuals receiving less NHS funding and others more, also impacting social care funding arrangements. In some parts of the system, that meant we gave less award of continuing health care. In other parts of the system, it meant that we started to give more.
This is true for adults and children across the system. The process involved reviewing individuals who were previously receiving fully funded NHS care, and if the review identified they were no longer eligible for NHS funding, corrective action was taken. This has also impacted social care funding arrangements, as social care were going to feel some of that impact, because we had stepped in. It meant that they had not needed to step in with support for some of the services that we are now then saying we're no longer going to fund from the NHS, but it does mean that social services will see some change in terms of how our split of funding will happen.
The transformation of continuing care began three years ago, and the process of implementing the national framework is ongoing. We have a programme of work that we are live in the middle of now, but that programme of work, again, is not related to the workforce that we have. It's about how we implement what the CARE Act would say the local authorities should implement. The NHS framework says that we should implement as an NHS, and we need to make sure that we do that jointly to make sure that families get the best service that they can.
The report does not provide a specific projected timeline for full implementation or detailed long-term impacts on NHS and local authority funding, beyond the immediate impact of increased local authority funding contributions to compensate for reductions in health funding.
