In 2024, we undertook an extensive public consultation in partnership with NHS England Specialised Commissioning under the North Central London Start Well Programme, on proposals to change the way some surgical services for young children are delivered.
The Start Well programme has involved several years of close partnership working and significant engagement with patients, clinicians and partners to review and improve the quality and outcomes of services. Our collective ambition as a health and care system is to give babies and children living in Barnet, Camden, Enfield, Haringey and Islington the best possible start in life and improve health outcomes.
Why changes are needed
There are opportunities for us to improve the quality of children’s surgical services, for both planned and emergency care, to improve outcomes, as well as to provide a better experience for young children, their families, carers, and our staff too.
Our case for change highlighted the following:
- Services and pathways for children’s emergency surgery are currently inconsistent and unclear meaning staff often spend a lot of time finding a hospital that can deliver care in an emergency.
- Not all hospitals have the same types and number of specialists who are able to operate on very young children, so they can’t treat children consistently.
- Some hospitals see very small numbers of children for certain types of surgery, making it difficult for staff to learn and practice specialist skills.
- We need to reduce waiting times for planned surgery.
We want to ensure that young children get the surgery and care they need as quickly as possible, in age-appropriate and child friendly environments.
Our initial proposals for children’s surgical care
During the consultation period we engaged with residents, staff and wider stakeholders to seek their views on the following proposals:
- Setting up ‘centres of expertise’ or specialist centres centralising more specialist surgery for young children.
- University College London Hospitals NHS Foundation Trust (UCLH) as the centre of expertise for planned day case care
- Great Ormond Street Hospital for Children NHS Foundation Trust to be the centre of expertise for inpatient care and also the centre of expertise for emergency surgical care for young children.
More details about the proposals and the case for change are available in our consultation document.
Consultation feedback and additional engagement
Following our public consultation, we published a full independent report detailing the responses we received along with an executive summary report.
Having considered this feedback and suggested alternative options, we then carried out further engagement activity during June and July 2025 specifically focused on our updated proposal for emergency surgery for young children. All elements of our previous proposals for children’s surgery remained unchanged; UCLH will still be the main centre for day case procedures and Great Ormond Street Hospital for planned inpatient procedures.
Our updated proposal for emergency surgical care
Under our updated proposal, young children who need emergency surgery would be transferred to a specialist centre, to either hospitals in West London Children’s Healthcare (primarily The Chelsea and Westminster Hospital and St Mary’s Hospital) or to The Royal London Hospital. These hospitals already provide specialist care for very young children in North London who need emergency surgery.
The hospital site young children would be transferred to would depend on which local hospital they initially go to for their emergency care.
Under this proposal, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) would continue to treat children who are medically and surgically complex and/or very high risk for anaesthesia, or who are already under the care of GOSH.
The feedback we received from parents, residents and clinicians during this additional phase of engagement has been independently analysed on behalf of NCL ICB.
Decision-making stage
Members of the ICB Board met on 30 September 2025 to carefully consider the feedback received during the consultation and engagement process, as well as other supporting evidence and data, to support them to make a final decision on the proposed changes to children’s surgical services.
The full decision-making business case and supporting documents are as follows:
- Start Well Decision-Making Business Case (DMBC) children’s surgical services proposals
- Integrated Impact Assessment (IIA)
- Additional engagement activity independent report
The Board agreed to the following recommendations:
- Young children (mostly under 3 years of age) requiring emergency surgery will be transferred from their local acute hospital to West London Children’s Healthcare (St Mary’s Hospital, Chelsea and Westminster Hospital) or The Royal London Hospital. These hospitals already provide specialist care for young children in North London who need emergency surgery.
- Emergency surgery for ear, nose and throat (ENT) will be treated by exception at Great Ormond Street Hospital and UCLH.
- Great Ormond Street Hospital will continue to treat some children who are medically and surgically complex or already under the care of the hospital, and also newborns.
Children should continue to access care at their local hospital emergency department, as they do now, and will only be transferred for emergency care at a specialist hospital, if clinically necessary.
- For planned inpatient surgery young children will receive their care at Great Ormond Street Hospital or UCLH
- Day case surgery for young children will take place at UCLH
For the majority of children’s surgery there will be no change to existing arrangements, so in summary:
- Barnet Hospital, North Middlesex Hospital, Royal Free Hospital, UCLH and Whittington Health will continue to provide:
- emergency surgery for children aged 5 years and over
- orthopaedic, ENT and maxillo-facial for children aged 3-4 years
- ENT and dentistry day case surgery for child aged 3+ (plus those requiring a single overnight stay) where they do now.
- Surgical activity delivered at highly specialist units, such as neurosurgery, cardiothoracic surgery, major trauma and ophthalmology will continue to be delivered in line with the current pathways of care.
The agreed recommendations also include a provision to work with the North Thames Paediatric Network to support the implementation of the proposals and to establish a referral hub for referring hospitals in North Central London. Setting up agreed systems and processes, especially for emergency surgery, will help speed up treatment and reduce the time staff currently spend finding a hospital that can deliver care in an emergency.
Next steps
Now that the ICB Board has approved the proposals, work will now commence to plan and manage the implementation of the agreed changes through the NCL Start Well Programme Board in collaboration with the North Thames Paediatric Network.