Trust strategy 2026-2031

We are excited to introduce our strategy for South West London and St George’s Mental Health NHS Trust. It sets out an ambitious direction for the next five years, rooted in our mission to Make Life Better Together. Over the past five years, both our Trust and the world around us have changed significantly.

We have lived through a pandemic and continue to face global uncertainty that is shaping people’s lives. At the same time, the NHS is evolving, with new expectations around access and care delivery. Together, these changes are driving more complex mental health need, and a recognition that care should be personalised, joined-up and responsive. We have responded by transforming our estate, including the redevelopment of Springfield University Hospital and the creation of Springfield Village as a community asset. This has strengthened partnerships and our role as an anchor institution.

We have also expanded and integrated services, maintained our Good CQC rating, and built a more stable workforce with reduced vacancies and turnover. We have sharpened our focus on inclusivity, anti-racism and reducing health inequalities, embedding these more consistently in how we design and deliver care. This progress gives us strong foundations for the future, while recognising there is more to do. 
 
This strategy has been shaped by people with lived experience, colleagues and partners. What we heard was clear: people want earlier help, simpler pathways, integration between mental and physical healthcare, and environments that feel safe and therapeutic. 
 
This Strategy focuses on the outcomes that matter most across our four strategic ambitions: Increasing Quality Years, Reducing Inequalities, Making the Trust a Great Place to Work and Ensuring Sustainability. We have also elevated Working in Partnership through this strategy. Partnership is not just one of these ambitions – it is how we will deliver all of them.

Looking ahead, we will complete the redevelopment at Tolworth Hospital, creating a second centre of excellence. We will continue to shift care closer to home – supporting people earlier, reducing avoidable admissions, and ensuring care supports timely recovery in the community. We will maintain our laser focus on reducing inequalities and make better use of digital to improve productivity and experience. 
 
We will also go further in how we work with our communities and partners – developing integrated neighbourhood models of care and placing mental health and wellbeing at the heart of everyday life. 
 
As a Board, we are committed to delivering this Strategy. We will continue to put co-production with patients and carers, quality improvement, inclusivity and anti-racism at the centre of how we design and deliver services, support our colleagues and strengthen collaboration. 
 
We thank everyone who has contributed to this Strategy. We are proud of what we have achieved together – and confident in what we will achieve next. 
 
Ann Beasley CBE, Chair 
Vanessa Ford MBE, Chief Executive 

This refreshed Strategy sets out South West London and St George’s Mental Health NHS Trust’s direction for 2026–2031, building on the foundations of our 2018 Strategy and the significant progress achieved since then. Over the past five years we have modernised our estate, strengthened the quality of our services and expanded access across our five boroughs. At the same time, demand, complexity and expectations of mental health services have continued to grow, requiring us to go further and faster in how we design and deliver care. 
 
The Strategy responds to rising and increasingly complex mental health needs across all age groups, sustained pressure in crisis, community, neurodevelopmental and specialist pathways, and national priorities that emphasise prevention, earlier intervention, integration, equity and digital transformation. Informed by extensive engagement with people with lived experience, carers, staff and partners, it sets a clear direction for delivering more timely, consistent and joined‑up care, reducing unwarranted variation, and strengthening the connection between mental and physical health. 
 
Children and young people are a major focus of this Strategy. Rapidly increasing neurodevelopmental demand and rising complexity require clearer, fairer and more integrated models of support across health, education, local authorities and the voluntary sector. We are committed to delivering coherent, evidence‑based CAMHS and all‑age eating disorder pathways, alongside a more responsive and equitable neurodevelopmental offer that provides support before, during and after assessment. 
 
Tackling inequalities is central to this Strategy. We will be actively anti‑racist and inclusive, addressing persistent disparities in access, experience and outcomes, particularly for people from Black and minority ethnic communities and those living in areas of deprivation. Through the Patient and Carer Race Equality Framework, community partnership and population‑health approaches, we will reduce restrictive practices, improve physical health outcomes, and ensure care is culturally responsive and equitable across pathways. 
 
The Strategy also places strong emphasis on partnership and neighbourhood‑based models of care. Working with primary care, local authorities, Voluntary, Community and Social Enterprise (VCSE) partners and communities, we will embed mental health within integrated neighbourhood teams, strengthen prevention and early intervention, and address the wider determinants of mental health such as housing, employment and social connection. Co‑production with people with lived experience and carers will be the default way we design, deliver and improve services.   
 
Delivering this Strategy depends on our people, our culture and our ability to improve continuously. We will support colleagues through further transformation, investing in compassionate leadership, new skills, digital capability and multidisciplinary ways of working to enable safe, sustainable and modern models of care. A strengthened Quality Management System will underpin delivery, ensuring consistent standards, learning and improvement across the Trust. 
 
Finally, the Strategy sets out how we will ensure long‑term sustainability. We will complete our Better Environments programme, expand digital‑enabled access, improve productivity and value, reduce unwarranted variation and deliver greener, lower‑carbon services. We remain focused on serving our local population, contributing specialist expertise where it adds value, and playing a strong system leadership role across south west London. 
 
Together, this Strategy positions the Trust to deliver high‑quality, equitable and sustainable mental health care that is rooted in communities, shaped by lived experience and focused on improving outcomes and quality of life for the people we serve. 

Key demographic trends

We serve a diverse and changing population across the five boroughs of Kingston upon Thames, Merton, Richmond upon Thames, Sutton and Wandsworth. The population is now around 1.1 million and has grown by nearly 7% since 2011, broadly in line with national and London trends, though growth has been uneven across boroughs, with Sutton experiencing particularly rapid change1. Alongside overall growth, communities across south west London have become more diverse and more complex, reflecting wider demographic change across the capital.

Age

Our population profile reflects change at both ends of the age spectrum. Overall, south west London has grown older, with numbers aged 65 and over increasing by nearly 19% since 2011, most notably in Richmond1, reflecting longer life expectancy and demographic ageing. At the same time, the population of children and young people has grown more rapidly than the adult population, with under-15s increasing by around 9% over the same period1. Working-age adults continue to represent the largest proportion of the population across all boroughs, meaning south west London is characterised by a broad and changing age profile spanning early life, working age and older adulthood.

Ethnicity

South west London is home to increasingly diverse communities, with significant variation in ethnic composition across boroughs and neighbourhoods. While the population remains predominantly White overall (around 69%), Asian communities now make up around 15% of the population1, alongside growing Black and mixed-ethnicity communities, particularly in Kingston, Merton and parts of Wandsworth. In several boroughs, children and young people from Black, Asian and minority ethnic backgrounds represent a larger share of the younger population than the adult population, reflecting ongoing demographic change and the evolving composition of communities across south west London.

Deprivation

Although our boroughs are, on average, less deprived than many parts of London and England, each contains distinct pockets of significant deprivation. These localised neighbourhoods often sit alongside areas of relative affluence, a pattern typical of London, where disadvantage is concentrated in small clusters rather than being evenly spread. Wandsworth and Merton contain several neighbourhoods within the most deprived national deciles, while Sutton has concentrated pockets of deprivation in its north and central areas. Kingston and Richmond contain smaller but still meaningful hotspots. These variations shape mental health demand and contribute to differences in outcomes across our geography. These areas closely align with Core20Plus populations in Sutton, Wandsworth and Merton, where deprivation intersects with ethnicity, long‑term conditions and lower access to preventative support. People in these neighbourhoods typically experience higher levels of unmet or more complex mental-health need, are more likely to require intensive support, and face an elevated risk of poorer outcomes without targeted action.

Prevalence and forecasts

The impact of the Covid-19 pandemic on the nation’s health cannot be understated, and this is evident in our local prevalence data since 2020. Mental health need has risen across all age groups, with distinct patterns emerging. For children and young people, the impact has been particularly significant. All boroughs saw an increase in children and young people requiring additional social, emotional or mental health support, with Merton and Wandsworth continuing to exceed England levels. South west London also saw marked increases in self-harm admissions for 10-24-year-olds during 2020-22. These have largely returned to pre-pandemic levels, although Kingston and Richmond, our two least deprived and least diverse boroughs, saw the most pronounced rises, with Kingston exceeding the England average in 2020-2021 and 2021-2022. Access to Trust self-harm pathways also increased during this period.

Since our 2018 strategy, recorded prevalence of serious mental illness (schizophrenia, bipolar affective disorder and other psychoses) in south west London has increased by 14.8%. This rise is greater than reported national trends and reflects both genuine increases in complexity and improved identification across our system4. Depression has seen the sharpest rise at 62.1%, and modelling suggests this will continue to be a major driver of demand if not addressed through earlier intervention and prevention. Merton and Sutton sit above the England average for overall mental health prevalence, while Wandsworth is broadly in line; all boroughs remain below the England average for depression specifically. People living with serious mental illness experience significantly reduced life expectancy, often 15-20 years shorter than the general population, driven by preventable physical health conditions and inequities in access to care. While premature mortality for adults with Serious Mental Illness (SMI) is better than the England average across our boroughs, there is substantial variation between them, with Wandsworth performing worst4. Our ageing population contributes further to rising need. Dementia prevalence is highest in Richmond and Sutton, reflecting demographic change; Richmond remains just below the England average while Sutton aligns with it. Neurodevelopmental need has risen substantially. National data shows a marked rise in ADHD prevalence. The 2023/24 Adult Psychiatric Morbidity Survey reports that 1 in 7 adults (13.9%) now screen positive, up from 8.2% in 2007 and 9.7% in 2014, equivalent to around 6.5 million adults. Rates are highest in young adults (25% of 16-24-year-olds) and higher in women than men, with public recognition also increasing: 5.8% of adults believe they have ADHD, compared with 1.8% reporting a diagnosis. As no borough-level prevalence data exists, local interpretation for south west London is necessarily inferential. Given the younger population profiles of Wandsworth, Merton and Kingston, and the strong national associations between ADHD and socioeconomic disadvantage (including unemployment, economic inactivity and problem debt), local prevalence is likely to be similar to or above national rates. Prescribing patterns reinforce this, with ADHD medication use increasing 18% annually nationally since 2019/20 and London showing the fastest growth at 28% per year, indicating rapidly rising recognition across the region. 

The relationship between deprivation and prevalence

Deprivation is one of the strongest predictors of mental health prevalence and intensive service use across our boroughs. In Sutton, Wandsworth and Merton, larger Core20Plus populations experience higher rates of both common and severe mental illness, with greater complexity and higher likelihood of crisis or intensive support. In Merton, for example, Core20Plus groups generate a disproportionately high share of activity relative to their population size. Even in Richmond and Kingston, where overall deprivation is lower, small pockets of deprivation are associated with markedly higher and more complex need, reinforcing the close link between socioeconomic disadvantage, acuity and poorer outcomes. A clear understanding of our population and how it is changing supports us to define clear goals around access, experience and outcomes for service users, carers and families.

 

NHS 10‑year plan priorities, the public sector environment and regulatory expectations

The national health and care landscape is undergoing significant transformation, shaped by the government’s 10‑Year Health Plan and the wider pressures facing the NHS and public sector. The Plan sets out three major system-wide shifts essential for long-term sustainability:

• From hospital to community, with sustained investment in primary and community services to ease pressure on secondary care.
• From analogue to digital, accelerating adoption of data, digital tools, and AI to provide instant access to advice and appointments while modernising care delivery.
• From sickness to prevention, shifting the model toward prediction and early intervention to tackle rising multimorbidity, ageing populations and persistent inequalities.

It envisages a re‑designed NHS that offers better access, greater patient choice and more personalised support, enabled through stronger partnerships across life sciences, local government and the voluntary sector. Delivering this vision requires the NHS to: 

• Recover core services by improving waiting times and expanding capacity, including through community diagnostic models.
• Strengthen primary, community and mental health care, improving access across GP, pharmacy, school and community settings.
• Modernise access and care delivery through digital tools, data, AI and more personalised support.
• Improve productivity, workforce experience and financial sustainability, including annual efficiency gains and better staff retention.
• Shift further towards prevention and population health, improving safety and narrowing inequalities, with a focus on Core20Plus groups.

A key tenet of the policy is the development of integrated and neighbourhood care and the government has published a Neighbourhood Health Framework (March 2026) to support this work. The framework establishes five national minimum goals (including improved population health outcomes, better access to general practice, improved planned and urgent care, and patient and staff experience), underpinned by common outcomes and metrics, while allowing local areas flexibility to respond to local need. Delivery is structured around Integrated Neighbourhood Teams (INTs), new provider and commissioning models, and a phased implementation starting in 2026/27, supported by the National Neighbourhood Health Implementation Programme and aligned with wider agendas. The framework offers an opportunity to rebalance mental health care towards prevention, earlier support and community-based provision by embedding mental health directly within neighbourhood-level Integrated Neighbourhood Teams alongside primary care, community services and social care.

Alongside these national priorities, the wider NHS and public sector environment is marked by sustained operational pressures, significant scrutiny of financial discipline and ongoing structural reform. Local authorities, facing rising demand, workforce shortages and long-term funding constraints, are under increasing strain in areas such as social care, housing and public health, all of which directly influence the pressures on mental health services. At the same time, ambitions to strengthen the UK’s position in life sciences and clinical research are accelerating expectations around trial delivery, access to innovation and the use of real-world data, supported by investment in digital infrastructure and system-wide productivity initiatives.

Alongside the focus on strategic development, the NHS Oversight Framework places greater emphasis on financial sustainability, productivity and quality, alongside more consistent assessment of providers and Integrated Care Boards. The Care Quality Commission is strengthening its approach to system and provider oversight, with a greater focus on quality, safety and leadership across integrated pathways. Professional regulation is adapting to support new multidisciplinary and digitally enabled models of care, while medicines and device regulation is shifting towards more agile, science-led approaches that strengthen safety, data quality and clinical governance.

Finally, forthcoming changes to the Mental Health Act will place greater emphasis on patient rights, reduced coercion and improved cultural competence, requiring providers to strengthen practice, workforce capability and oversight of detention, restrictive interventions and the use of the Act.

South West London Integrated Care Board (SWL ICB) is currently in the process of developing its Clinically-Led Strategic Plan (CLSP). The CLSP aims to address a number of significant challenges facing the south west London system, including:

• Variation in quality, outcomes and widening health inequalities
• An ageing population with rising, complex needs
• Rising demand for healthcare
• A workforce under pressure
• Poor estates and infrastructure
• Significant financial challenge

CLSP analysis has identified several areas of material forecast growth in depression prevalence over the next ten years, high prevalence of depression in those living with long-term physical health conditions, and a growing prevalence of SMI in south west London, with higher prevalence than the national average (driven largely by Merton and Croydon).

We are working with partners and stakeholders to respond to these challenges with a focus on reducing unwarranted variation in mental health services between places, optimising treatment and care models for SMI and developing approaches to prevent and intervene earlier in depression. All of these areas support the delivery of the South West London Mental Health Strategy commitments and our work in place partnerships with statutory and voluntary sector colleagues. The Integrated Care System (ICS) has made a commitment to support the CLSP with a three-to-five-year funding transfer plan that supports the NHS left shift.

In addition to working as a core partner in the south west London system, we continue to work closely with neighbouring mental health trusts – South London and Maudsley Mental Health NHS Foundation Trust and Oxleas NHS Foundation Trust – through the South London Mental Health and Community Partnership (SLP). Through the SLP we advocate for mental health and users of mental health services and we have delivered considerable impactful improvements through delegated commissioning arrangements and budgets totalling nearly £200m per year in specialist care pathways in CAMHS, Adult Eating Disorders, Secure Care, Perinatal and mental health rehabilitation. We continue to work to develop end to end pathways, focus on outcomes and design care to meet population needs.

Service description 

South West London and St George’s is a forward-thinking and diverse mental health provider delivering care across four service lines:

• Acute and Urgent Care
• Community Adult services
• Child and Adolescent Mental Health and all age specialist Eating Disorders
• Specialist services, including national Forensics, Deaf Mental Health and OCD/BDD, as well as Neuropsychiatry, Learning Disabilities and Cognition and Mental Health in Ageing

We balance serving the five boroughs of south west London, with the provision of specialist expertise to patients regionally and nationally and our services are recognised centres of excellence. This dual role, grounded in our local communities but contributing nationally to the development and delivery of specialist mental health care, is a defining feature of our Trust.

Services are clinically led and delivered across our five boroughs, from two main inpatient sites – Springfield and Tolworth – and extensive community locations, including GP practices and borough-based hubs.

The last five years have seen us deliver one of the most substantial estate modernisation programmes in the country. The redevelopment of Springfield Hospital, including the creation of Springfield Village, has provided state-of-the-art inpatient facilities and established the Trust as an anchor institution within the local community, offering therapeutic environments, green space, new amenities and improved public access, and creating a vibrant, integrated health and community setting.

With the redevelopment of Tolworth, Barnes and Richmond Royal, we are now completing the final phase of this work. Overall our Better Environments programme enables us to consolidate inpatient and community services into high-quality, digitally enabled, trauma-informed environments that support contemporary models of care and allow us to shift more of our clinical focus into neighbourhoods and community partnership working.

Activity, demand and pathway pressures

Across all services, our modernised facilities, digital improvements and strong clinical leadership have given us a solid operational foundation. However, this sits within a context of rising acuity, increasing demand across pathways, particularly crisis care, CAMHS, neurodevelopmental pathways and adult community services, and growing complexity of need across our population. These pressures shape the challenges and opportunities set out in the rest of this strategy and reinforce the need for ongoing transformation and improvement. Since 2017-2018, access to our services has increased by nearly 40%, with particularly sharp increases in Merton, Richmond and Sutton. This reflects both rising population need and increased visibility and accessibility of mental health services across the system. Demand growth is most pronounced in crisis services, children and young people’s (CYP) services and neurodevelopmental pathways, creating new pressures on capacity, flow and waiting times.

Inpatient care 

Admissions to adult acute beds have reduced by 27.9% since 2018 in line with our planned bed reduction and transformation of the acute care pathway, although people admitted now often present with higher acuity and more complex needs. Length of stay has increased, reflecting challenges in managing flow, delayed discharge and community capacity. There has also been a marked shift in demographic profile: admissions are now majority female, and the proportion of patients from Black, Asian and Minority Ethnic backgrounds has risen from 36.2% to 46.4% since 2017-2018, which is an over-representation compared with the south west London population.

Crisis and urgent care 

Presentations to Psychiatric Liaison services have increased by 25.9%, driven by wider system pressures and changes in urgent care pathways. Our crisis pathway remains one of our most challenged areas where work is already underway to redesign the pathway to better meet patient needs, improve experience at the point of crisis, and divert people away from A&E, seeing them closer to home and preventing unnecessary admissions to inpatient beds.

Adult community services 

Referrals to adult community services have increased by 10.8% since 2017-2018, with caseloads rising by 11.1%, particularly following delivery of the Community Transformation programme between 2021–2024 which aimed to improve access where needed. Although our referral rates remain lower than many peers, high and increasingly complex caseloads, driven largely by challenges stepping people down safely, continue to place sustained pressure on teams. While our waiting times benchmark in the lower quartile nationally, the length of time people remain on community caseloads is in the upper quartile, which contributes to waits feeling long locally and can affect people’s experience of continuity and recovery, despite favourable external benchmarking.

Neurodiversity