Board members of NHS North Central London Integrated Care Board (NCL ICB) met on Tuesday 30 September 2025 to make a final decision on proposed changes to children’s surgical services. These changes to both planned and emergency surgical care will affect a small number of young children (mostly under 3 years of age) who live in North Central London – covering Barnet, Camden, Enfield, Haringey and Islington.
The decision follows an extensive public consultation undertaken last year by NCL ICB and NHS England Specialised Commissioning under the NCL Start Well Programme. The consultation sought views from staff, families with experience of using these services and local residents on proposals to change the way some surgical services for young children are delivered. A further period of additional engagement activity was carried out during June and July this year, which focused specifically on an updated proposal for emergency surgery for young children.
Before making a final decision, Board members carefully considered the detailed decision-making business case, the latest integrated impact assessment, the independent report from the additional engagement activity as well as the feedback received during the consultation phase. These papers are available to download from the NCL ICB Board of Members meetings page.
The Board agreed to the following recommendations:
- Young children 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 children who are medically and surgically complex or already under the care of the hospital, and also newborns (neonates).
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 current arrangements, as 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.
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 an emergency referral hub for referring hospitals within the North Central London area. This referral hub will support clinicians to get advice, assessment or care for young children in a more timely way at the hospital best placed to support the child’s needs.
These changes will mean clearer, more consistent services and pathways, for both planned and emergency care, so that young children receive the specialist surgery and care they need without delay.
Dr Jo Sauvage, Chief Medical Officer, NHS North London Integrated Care Board, said:
“This decision represents an opportunity for us to make significant improvements to planned and emergency care for very young children, that will help to improve outcomes, and provide a better patient experience for these children, their families and carers, and for staff too.
“Currently, services for children’s emergency surgery in particular are inconsistent and unclear, meaning hospital staff often spend a lot of time finding a hospital that can deliver the specialist care needed in an emergency. We want to ensure that young children get the care they need as quickly as possible, in age-appropriate and child friendly environments.”
Mr Nic Alexander, consultant paediatric surgeon at Imperial College Healthcare NHS Trust and Chelsea and Westminster and Clinical Director of the North Thames Paediatric Network, said:
“We are delighted to collaborate with NCL ICB and system partners to design and deliver a referral hub, which will coordinate and standardise pathways of care to support clinicians so that young children receive high quality surgical care at the right place and at the right time.”
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.
Notes
- The NCL 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.
- NCL ICB ran a public consultation on behalf of the local health and care system between December 2023 and March 2024 on proposed changes to children’s surgical care (and also maternity and neonatal services). Please see the full independent report detailing the responses received to our consultation and executive summary report.
- The North Thames Paediatric Network is a collaboration of service providers working to improve the health and care of children and young people in North London and the North Thames area.