Catherine Fraher, Innovation Lead, and Debbie So, Senior Innovation Manager, reflect on why our Mission to support children and young people’s mental health is focusing on ND pathways
It’s no surprise that children and young people’s mental health services across North West London (NWL) are operating under sustained and increasing pressure. Demand continues to rise, workforce capacity remains constrained, and services are increasingly required to manage risk while navigating long waiting lists and fragmented pathways.
Neurodevelopmental (ND) services are where these pressures are most visible. In 24/25, more than 6,500 children and young people were waiting for ND assessment across NWL, with over 9,000 new referrals each year. Both figures are increasing at 12–13% year on year. These trends reflect national patterns, but their consequences are felt daily by children and young people, their families and carers, and our local clinicians and operational teams.
Long waits to assessment and diagnosis mean children and their families and carers may receive too little support during critical developmental periods. For services, this can result in repeated contacts, rising acuity, increasing administrative burden, and difficulty prioritising those with the highest levels of need. ND waiting times contribute to wider system pressures, including escalation into crisis services and increased use of emergency care.
Why our Mission to support children and young people’s mental health is focusing on ND pathways
Our Mission to support children and young people’s mental health was established to reduce the number of children and young people presenting in crisis and improve screening, supporting and signposting for those on ND waiting lists. ND waiting lists are a “burning platform” locally and nationally, a significant driver of pressure across the wider mental health system and a barrier to delivering timely, effective support. For 2026–27, this Mission will focus on ND pathways, aligned with:
Our aim is to work alongside providers to improve how demand is managed, how pathways operate and, most importantly, how children and families access support. For providers, this means more efficient and transparent pathways, better use of clinical and administrative time, and improved flow through the system. For children and families, it should result in a clearer, more consistent journey, with an earlier understanding of their needs and quicker access to appropriate support.
Over time, strengthening ND pathways in this way supports a shift away from long and often distressing waits for diagnosis, towards a more proactive, needs-led approach that can reduce uncertainty, ease pressure on families, and help build confidence in managing a child’s needs.
Improving the status quo using our ND digital pathway solution
One immediate priority is improving how children, families and carers enter and move through existing ND pathways. Working with clinicians and operational teams across NWL, alongside families and professionals who make referrals, we took a co-design approach to developing an ND digital pathway solution. This included walking through existing pathways with Child Development Teams and CAMHS across NWL, jointly mapping pain points and exploring what changes would make the greatest difference in day-to-day practice.
This work responds directly to issues consistently raised by services and families: incomplete and rejected referrals, limited communication and transparency, delays in information gathering, variable triage processes, and delays before clinical review. The digital pathway is designed to integrate with multiple electronic patient record systems and connect with the NHS App, reflecting practical service requirements rather than adding new standalone systems.
We have secured a £250k investment which will support implementation across six NWL services in Phase 1 and further services in Phase 2, with delivery and evaluation continuing through 2026/27. By Q2 26/27 we hope to start seeing positive impact:
- reducing administrative and clinical time per referral
- improving referral quality and acceptance first time
- reducing delays caused by missing information
- improving experience for families, referrers, clinicians and administrators
“The ND Pathway Solution supports the ongoing transformation of our assessment and support services for neurodevelopmental needs. We need to keep delivering change and improvement to help children, young people and their families. This work will directly improve experiences and speed, join up the innovation work that’s already in progress, and enable us to update our service delivery more easily in future. We believe it will enable future transformation across the NWL system.” – Dr Johan Redelinghuys, Clinical Director – Children and Adolescent Mental Health Services (CAMHS), West London NHS Trust
Beyond diagnosis: testing a needs-led approach
While optimising the existing diagnosis-led ND pathway is necessary, the scale of unmet ND demand tells us that we need to act collectively to change the approach to ND and promoting diagnosis is both unsustainable and unhelpful.
Not every child referred for ND assessment requires, or wants, a formal diagnosis. However, every child does require timely, appropriate support. Decoupling access to support from diagnosis and offering earlier needs-based intervention through schools could reduce pressure on specialist services while improving outcomes.
Alongside ND pathway optimisation, we intend to pilot a needs-led ND profiling approach building on pioneering work in other parts of the country including Portsmouth, Cambridgeshire and Bedfordshire. This would assess strengths and needs earlier (typically in school settings), connect children to appropriate support without waiting for diagnosis, and retain specialist clinical input for those who need it most. While reported reductions in referrals elsewhere range from 15–40%, we require a carefully designed pilot to be co-designed with NWL stakeholders, explore the digital and data infrastructure required to scale, and establish an alternative vision for ND support based on evidence, impact and feasibility.
What this means for providers
For providers across NWL, this Mission-led approach is intended to be practical, collaborative and transformational. Our immediate focus is on improving day-to-day functioning of ND pathways, reducing avoidable workload, and improving flow. Longer term, our aim is to generate evidence about whether a radical left-shift from diagnosis to needs-led support can help services manage demand more sustainably.
That’s the power of the mission model: to convene, listen to each other, collaborate, and co-design, working together to get the system moving. And ICHP is uniquely placed to do this – bringing health, community, industry, innovators and families together; offering our specialist skills to help realise their collective vision and bring about a better way of supporting people.
Want to learn more about the ND digital pathway, ND profiling, or find out more?
