Merton residents could see changes in their healthcare as the South West London Integrated Care Board (SWL ICB) grapples with significant management cost reductions. The Healthier Communities and Older People Overview and Scrutiny Panel heard on Thursday 11 September 2025, that the ICB must cut management costs by 58% by December 2025, to realise savings by 1 April 2026.
The cuts are part of a national directive issued in March 2025, requiring all ICBs in England to reduce management expenses by 50%, with the specific percentage varying based on current spending levels. For SWL ICB, the 58% reduction reflects historically higher management costs.
The savings target applies to management costs, not directly to commissioned services. However, the SWL ICB faces a challenging savings plan across all sectors to achieve a balanced budget.
Impact on Services
The panel heard that the functions of the ICB as a strategic commissioner will be:
- Understanding local context
- Developing Population Health Strategy
- Delivery of the strategy through payor and commissioning functions and resource allocation
- Evaluating impact
- Governance and core statutory functions
It is expected that strategic commissioning will remain with the ICB, while local commissioning will gradually shift to local partnerships. The partnership Alliance in Merton will eventually take on functions currently managed by the ICB. Neighbourhood service delivery will be delivered by partners across health, social care, and the voluntary sector. Continuing Healthcare (CHC) is likely to remain with the ICB for the foreseeable future, pending national review. Performance management of acute providers will move to NHS London region, while out-of-hospital services will be managed at the SWL ICB level. Service changes at all levels of the system will require equality and quality impact assessments. The future of safeguarding is under national consideration, as statutory functions held by the ICB would require legislative changes. The timeline for that national consideration is not specified.
Neighbourhood Integration
Neighbourhood-level integration is a national priority, with local organisations coordinating care. A London Target Operating Model for London for Integrated Neighbourhood Health has been published, outlining care delivery at the neighbourhood level across London. This model supports the transfer of some ICB functions to integrators and place partnerships over time, fostering a community-based approach to care.
In Merton, the partnership Alliance includes representatives from health, social care, and the voluntary sector, and will eventually assume some functions currently managed by the ICB.
Financial Risks
Panel members were warned that the financial risks associated with the transition are significant. The reduction in management costs could affect the capacity to transform services, and the ICB's overall financial position may limit opportunities for change.
Merton Alliance
The vision for the Merton Alliance has been collaboratively developed and defined as: Joined up support centred around community that enable people to live their fullest life.
Concerns
Panel members were warned that with any significant transition plan, there is a risk that the structural change distracts from the key aims of improving health service and health outcomes for the resident of Merton.
