erminous. Some local authorities must engage with more than one ICB, while ICBs and police forces often work across multiple local authority areas; this raises challenges in capacity for appropriate representation, commissioning arrangements and strategic and practical activities. Other issues raised include conflicting professional cultures and different policy targets in combination with a lack of cohesion and policy tensions between different government departments. Participants shared numerous comments about the difficulties experienced in engaging ICBs in the children’s agenda. I fear they think people are born as adults. We need a children’s plan. We’re working on that this year for our ICB, but it’s been years of banging the head and it’s a national problem. (DCS, Metropolitan, Yorkshire and Humber Region) From a DCS perspective, ICBs were described as ‘clunky and cumbersome’, dominated by centralised decision-making that was often difficult to understand, with priorities dominated by the needs of adults, particularly older adults. Accessing Continuing Care for children under section 117 of the Mental Health Act 1983 has been a particular area of contention, 13 In a further reorganisation of health services, ICBs replaced CCGs in 2022. 73 with many local authorities reporting resistance from ICBs to contribute to the costs of mental health aftercare for children and young people. In many areas, the financial pressures within ICBs have resulted in restricted access to mental health provision for children, particularly to in-patient Tier 4 provision. Where funding was available, DCSs reported challenges in accessing it. Every case is a battle with health – [starting] at the beginning with every single child, as if the conversations about previous children have not 