The Health Scrutiny Committee was scheduled to discuss intermediate care services, the East Midlands Ambulance Service, and the committee's work programme. A main focus of the meeting was to be a discussion of the case for changing intermediate care services in Derby and Derbyshire. Councillors were also expected to consider an update on the work done by the East Midlands Ambulance Service to improve its response times.

Intermediate Care

The committee was scheduled to discuss a report from the Derbyshire Community Health Services NHS Foundation Trust (DCHS) and NHS Derby and Derbyshire Integrated Care Board (ICB) regarding intermediate care services. Intermediate care services are short-term services intended to rehabilitate or re-able people, helping them regain independence. These services can be provided at home, in community beds, or in residential settings, and can be used to prevent hospital admissions or to support people returning home after a hospital stay.

The report outlined a Case for Change for intermediate care services in Derby and Derbyshire, explaining the reasons for change, the vision for future services, and the approach to public engagement through a listening exercise. The report noted that this work builds on efforts across health and care partners in Derby and Derbyshire to integrate teams, with the goal of helping people live independently at home for as long as possible.

Developments so far include:

• The formal integration of services between the DCHS and Derby City Council on 1 May 2024, creating a partnership known as Community First.
• The approval of the Discharge Improvement Strategy by the Joined-Up Care Derbyshire (JUCD) Integrated Place Executive (IPE) in September 2024.
• A public consultation held by Derbyshire County Council and DCHS between 5 December 2024 and 16 January 2025, regarding the formal partnership and integration of health and social care services for discharge, reablement, rehabilitation, and admission avoidance across Derbyshire.
• A decision in February 2025 by Derbyshire County Council’s Cabinet to consolidate their Community Support Beds by remodelling Ada Belfield, Meadow View, and Oaklands, expanding reablement at the Staveley Centre and Thomas Fields, and opening a new unit at Bennerley Fields.

The Case for Change identified several drivers for change in Derby and Derbyshire:

• The need for a more consistent care offer across intermediate care pathways.
• Capacity pressures due to an ageing population and constraints such as fragmented bed bases and limited weekend provision for home-based services.
• Duplication of information and recording across multiple systems.
• Workforce challenges, including differing staffing models and reliance on agency staff.
• The need to consolidate bedded care settings.
• Variations in estate quality.
• The need to improve value for money.

The Case for Change document sets out a Home First Vision for Intermediate Care services in Derby and Derbyshire. Key elements of this vision include:

• Enabling as many people as possible to return home after hospital, with ongoing care needs assessed outside hospital.
• Providing time-limited support at home wherever possible, ensuring that individuals and families are at the heart of decisions.
• Fully integrating health and social care teams to deliver coordinated, person-centred care.
• Increasing capacity by reviewing work patterns and processes to support more people outside of bedded care.
• Recognising intermediate care as a specialist service delivered by skilled teams in purpose-designed environments.
• Developing a resilient and well-trained workforce with standardised roles and clear career paths.
• Establishing embedded care transfer hubs to coordinate intermediate care.

A listening exercise was scheduled to run from February to April 2026, to gather public views on the vision, improvements, and considerations for implementing changes. The listening exercise was expected to seek views on the following questions:

• What are your views on the vision for intermediate care services?
• Is there any more we can do to improve intermediate care services so that more people return home quickly and safely from hospital, and people are helped to stay at home for longer?
• What is important to you, that we need to consider, if we were to implement the suggested changes?

The committee was asked to note the rationale and vision for change in Intermediate Care services, support the approach to public engagement through the listening exercise, and endorse the next steps as outlined in the Case for Change.

East Midlands Ambulance Service (EMAS)

The committee was scheduled to receive an update on the work done by the East Midlands Ambulance Service (EMAS) to improve response times, specifically for Category 2 (CAT2) calls¹. The update was expected to cover several areas:

• Communications: Influencing the public to 'choose wisely' when calling for an ambulance.
• Patient Safety and Experience: Prioritising patient safety and experience.
• Recruitment: Highlighting positive recruitment results, with EMAS currently over establishment.
• Critical Care Desk: The introduction of a Critical Care desk in the Emergency Operations Centre (EOC).
• Urgent and Emergency Care Recovery Plan: Working with the national team on internal efficiency, hear & treat strategies, job cycle, and post handover processes.
• ICB Focus: Reducing hours lost waiting at hospitals and reducing 999 incidents.
• Collaboration: Continuing collaboration between EMAS and DHU Healthcare focusing on 111/999 opportunities.

The presentation also included information on Hear & Treat strategies, which aim to manage incidents over the phone without dispatching an ambulance. Key points included:

• Full embedding of NHS Pathways².
• National C2 segmentation work.
• Increased clinicians in the EOC.
• Automated calls passed to Urgent Community Response (ITK – interoperability toolkit).
• Manual push of further incidents to Central Navigation Hub.
• Aim to deliver 20% Hear & Treat.
• Continued building of the Clinical Hub.

Regarding conveyance (transporting patients to hospital), the presentation noted the introduction/refreshing of a new process to support on-scene decision-making, including clinician-to-clinician conversations and navigation of patients to the most appropriate pathway. The aim is to improve the patient experience and ensure that all patients conveyed to the Emergency Department (ED) are appropriate for that level of care.

Hospital handover times continue to be a challenge, with difficulties in discharging patients from hospitals impacting patient flow and causing ambulances to wait to handover patients. EMAS continues to work with system partners to keep patients safe. University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) has redesigned its ED to increase capacity, and a 45-minute handover target was scheduled to go live in December. Processes are in place to ensure immediate and rapid handover for critical patients.

Total lost hours due to hospital handover delays from April 2025 to October 2025 were 13,025, equivalent to 1,085 12-hour shifts. This has a direct correlation to C2 performance and increases the risk to patients waiting for an emergency ambulance.

Overall, C2 performance is not being delivered, and Demand Capacity Assessment (DCA) hours are above core contractual levels. Resource efficiency work continues, focusing on on-scene time, see & treat, post handover processes, and vehicle availability. A rostering review has commenced, and October 2025 showed improvement compared to the previous year by 13 minutes.

Work Programme

The committee was scheduled to consider its current work programme and suggest items for future consideration. Items already scheduled for January 2026 included:

• Learning Disabilities (adults) – short breaks
• Fertility Review Update
• Stroke Rehabilitation
• Update from Healthwatch Derbyshire

Scheduled for March 2026:

• Sickle Cell Carrier Update

Later or possible items included:

• Dementia Strategy – update Spring 2026
• Living Disabilities Derbyshire – short breaks
• Further update from Healthwatch Derbyshire
• Asbestos
• Mental Health Crisis Support
• Screen time for children and young people's mental health
• Food Additives
• Long COVID
• End of Life Care
• Care and treatment of people with Dementia