We, and many stakeholders, agree that the introduction of ICSs offers opportunities to improve local mental health services. But many of the challenges they face involve longstanding and unresolved issues which we have repeatedly highlighted, most recently in our April 2023 report on the introduction of ICSs.33 Only four out of 29 ICBs responding to the NAO survey agreed they had the capacity, resources and staff required to improve their mental health services. As the Department acknowledged, “the proof will be in the pudding”.34 On workforce, NHSE told us that local ICSs are responsible for their own workforce planning. It recognised that there is a tension between central and local decision making, although it is not yet clear where the appropriate balance lies.35