The approved merger of North West London and North Central London Integrated Care Boards, due to take effect on 1 April 2026, will create the largest ICB in England, covering 13 boroughs and around 4.5 million people. The merger itself is not contested. What warrants scrutiny are the consequences of this scale for local accountability, particularly for Harrow and for adults and children with special needs.
ICBs decide how NHS funding is allocated locally, including services for people with disabilities, complex health needs, and safeguarding concerns. For Harrow residents, this is not abstract governance. As decision-making moves further from local communities, the risk is not simply reduced focus but reduced visibility. In larger systems, accountability must become clearer, not weaker.
Looked After Children are especially vulnerable during major system change. Their care depends on statutory NHS responsibilities, including designated doctors and nurses, health assessments, safeguarding escalation, and coordination across boroughs and providers. These arrangements exist to prevent vulnerable children being lost within complex systems.
In this context, current safeguarding transparency at ICB level is concerning. Public information describes roles, but does not clearly identify named statutory post-holders or provide straightforward routes for contact and escalation. Responsibility appears to sit behind generic inboxes, limiting visibility when serious concerns arise. This is compounded by outdated safeguarding information that does not consistently reflect current statutory guidance.
As things stand, Harrow residents cannot easily find clear explanations of how Children Looked After health responsibilities will operate after the merger, how safeguarding oversight will function across 13 boroughs, or how unresolved concerns will be carried through transition. Internal planning may exist, but public assurance matters when vulnerable children are involved.
Local authorities retain statutory responsibility for Looked After Children, raising legitimate questions about how Harrow-specific concerns will be heard within the largest ICB in the country. Scale can bring opportunity, but it can also bury risk. Clear, proactive transparency would strengthen confidence and help ensure that vulnerable adults and children are not overlooked in a larger system.
Also read our letter to the Secretary of State for Health and Social Care
ICBs decide how NHS funding is allocated locally, including services for people with disabilities, complex health needs, and safeguarding concerns. For Harrow residents, this is not abstract governance. As decision-making moves further from local communities, the risk is not simply reduced focus but reduced visibility. In larger systems, accountability must become clearer, not weaker.
Looked After Children are especially vulnerable during major system change. Their care depends on statutory NHS responsibilities, including designated doctors and nurses, health assessments, safeguarding escalation, and coordination across boroughs and providers. These arrangements exist to prevent vulnerable children being lost within complex systems.
In this context, current safeguarding transparency at ICB level is concerning. Public information describes roles, but does not clearly identify named statutory post-holders or provide straightforward routes for contact and escalation. Responsibility appears to sit behind generic inboxes, limiting visibility when serious concerns arise. This is compounded by outdated safeguarding information that does not consistently reflect current statutory guidance.
As things stand, Harrow residents cannot easily find clear explanations of how Children Looked After health responsibilities will operate after the merger, how safeguarding oversight will function across 13 boroughs, or how unresolved concerns will be carried through transition. Internal planning may exist, but public assurance matters when vulnerable children are involved.
Local authorities retain statutory responsibility for Looked After Children, raising legitimate questions about how Harrow-specific concerns will be heard within the largest ICB in the country. Scale can bring opportunity, but it can also bury risk. Clear, proactive transparency would strengthen confidence and help ensure that vulnerable adults and children are not overlooked in a larger system.
Also read our letter to the Secretary of State for Health and Social Care
Harrow Monitoring Group 