NHS restructuring: what the ICB mergers mean for therapy services in SE London and Kent

From 1 April 2026, the number of NHS Integrated Care Boards is being cut from 42 to 26. SE London and Kent & Medway are unchanged in this wave, but the 50% running cost reductions affect commissioning everywhere.

On 1 April 2026, the first wave of NHS Integrated Care Board (ICB) mergers took effect. Twelve ICBs were abolished and replaced by six new, larger organisations, primarily across London, the East of England, and the South East. A second wave is expected in April 2027, bringing the total number of ICBs down from 42 to approximately 26.

For families and professionals in our area: NHS South East London ICS and NHS Kent and Medway ICB are both unchanged in this wave. Your local commissioning structures remain the same for now. However, decisions on further mergers will be made in summer 2026, so this may change.

What matters more than the organisational chart is the 50% running cost reduction that NHS England has mandated across all ICBs. This is already leading to significant staff reductions. Some ICBs have reported losing half their workforce through voluntary redundancy and restructuring. Fewer commissioning staff means fewer people making decisions about therapy provision, longer waits for funding approvals, and a greater risk that children and adults with complex needs fall through gaps during the transition.

For families navigating the EHCP process, it helps to understand who is responsible for what. Your local authority SEND team coordinates the overall plan: the assessment, the drafting, the annual reviews. But for health provision specifically (Section G of the plan), it is the ICB that decides what goes in, and the ICB that has the legal duty to arrange it once it's there. The local authority cannot add or remove health provision from Section G without ICB agreement. Where physiotherapy is written into Section F as special educational provision, the duty to arrange it sits with the local authority instead. The ICB restructuring primarily affects Section G, and the commissioning teams responsible for it are under significant pressure from the staffing cuts. If your child's health provision has been delayed or not arranged despite being in the plan, this restructuring may be part of the reason.

Independent physiotherapy provision is not affected by ICB restructuring. Thrive continues to deliver therapy across SE London and Kent regardless of NHS organisational changes. For families who are experiencing gaps in NHS-commissioned provision, independent reports and therapy can bridge the gap. Where provision named in an EHCP is not being delivered, families have legal routes to enforce it.