The Health and Adult Care Scrutiny Committee met on Monday 23 March 2026 to discuss significant changes to the Integrated Care Board (ICB) structure, housing provision for adult social care, and progress on Deprivation of Liberty Safeguards. Key decisions included urging the ICB Chair to appoint a dedicated Devon County Council representative to the ICB Joint Committee and supporting the reinstatement of the Integrated Care Partnership. The committee also resolved to arrange a masterclass on specialist housing needs and to maintain ongoing oversight of this area.

Devon and Cornwall and Isles of Scilly Integrated Care Board (ICB) Clustering

The committee considered the emerging clustering arrangements for the Integrated Care Board (ICB) between Devon and Cornwall and Isles of Scilly. John Govett, Chair of the NHS Cornwall and Isles of Scilly and NHS Devon ICB Cluster, and Phillippa Harding, ICB Company Secretary, attended to discuss the report and respond to a letter from the committee's Chair.

Mr. Govett explained that the national requirement for ICBs to reduce running costs by 34% necessitated the clustering of Cornwall and Devon ICBs under a single governance structure. He confirmed that the statutory partner member on the ICB Board represents all councils within the footprint, and that the nomination for Devon had been agreed by Devon County Council, Torbay Council, and Plymouth City Council. He acknowledged that the relationship with Devon County Council needed strengthening and offered access to board papers as a gesture of transparency. He also confirmed that the ICB was restructuring its executive team to align senior officers more closely with local authorities and that the Integrated Care Partnership (ICP) would be reinstated as the statutory forum for discussing wider determinants of health.

Devon County Council officers emphasised that while operational relationships with NHS partners remained strong, concerns lay with governance, accountability, and fair representation. They clarified that Devon had not withdrawn from the ICP, which it had chaired, but that its activity had reduced following national policy changes. They highlighted Devon's complexity as the largest authority in the cluster and expressed concerns about risks to vulnerable services due to inadequate representation. The committee members expressed significant concern about the lack of direct democratic representation for Devon residents, describing it as a democratic deficit.

The committee resolved to support a reset of the working relationship between Devon County Council and the ICB, urging the ICB Chair to appoint a dedicated Devon County Council representative to the ICB Joint Committee to reflect Devon's population size and statutory responsibilities. They also supported the reinstatement of the ICP and sought a formal explanation from the ICB Chair regarding the decision-making process that led to Devon County Council not having direct representation on the cluster board.

Housing Update

The committee received an update on the housing roles of local authorities in two-tier areas, focusing on Devon County Council's strategic role and partnerships in adult social care. Councillor Richard Keeling, Cabinet Member for Adult Services, highlighted the administration's commitment to expanding Extra Care Housing provision, though current supply falls short of assessed need.

The report detailed the increasing demand for specialist and supported housing due to demographic pressures, including a growing older population and younger adults with complex needs. It was emphasised that suitable housing is fundamental to achieving positive social care outcomes, enabling independence, reducing reliance on long-term care, and supporting prevention strategies. The committee noted the significant variation in housing supply, planning capacity, and market conditions across different districts, underscoring the need for a coordinated approach.

New statutory requirements under the Supported Housing (Regulatory Oversight) Act 2023 were discussed, with officers explaining that district councils have a duty to prepare Supported Housing Strategies by 2027, and Devon County Council has essential statutory and commissioning responsibilities in this process. The committee also considered how the housing system would support hospital discharge pathways and noted ongoing work with The Housing Learning and Improvement Network to produce a Specialist Housing Needs Assessment.

The committee resolved to arrange a masterclass shortly after the completion of the Specialist Housing Needs Assessment and to include ongoing oversight of housing in its work programme.

Deprivation of Liberty Safeguards

An update was provided on the progress of the Deprivation of Liberty Safeguards (DoLS) service following significant investment. Officers reported substantial improvements, including better triage of high-risk cases, reduced waiting lists, and enhanced quality assurance. However, challenges persist, such as a high volume of incoming referrals and shortages of key roles like Best Interest Assessors (BIAs), Section 12-approved doctors, and Independent Mental Capacity Advocates (IMCAs).

Discussion points included the use of agency staff, the sustainability of improvements amidst national workforce shortages, and the emotional impact on staff. Members acknowledged the significant progress made in reducing waiting times and welcomed the proposal for a masterclass. The Chair requested continued regular updates until the service reached a stable and sustainable position.

End of Life Care Task Group

The committee received a presentation from NHS Devon following recommendations made by the End of Life Care Task Group in January 2025. Karen Barry, Locality Director for NHS Devon, and Emma Bagwell, Associate Director of Patient Care for Community Services at Royal Devon University Healthcare NHS Foundation Trust, outlined ongoing work. This includes re-establishing the Gold Standards Framework (GSF) for earlier identification of end-of-life care needs, developing a unified Devon-wide model for hospice-at-home services, expanding the use of electronic Treatment Escalation Plans (eTEP), and improving after-death care processes.

Discussions covered the importance of equitable access, particularly in rural areas, variability in GP capacity for early identification, challenges faced by unpaid carers, and the need for improved communication to prevent avoidable hospital admissions. The committee welcomed the presented initiatives and noted their alignment with the Council's prevention and wellbeing priorities. The Chair advised that the committee would maintain oversight of this issue and requested a more focused response from NHS colleagues regarding the Task Group's recommendations.

CoLab, Exeter Site Visit

Members noted the report on the committee's visit to CoLab, Exeter. The discussion focused on the importance of multi-agency hubs for individuals with complex needs, including homelessness, trauma, and substance misuse. Members praised the innovative partnership working and emphasised the need for sustainable funding. The Chair highlighted the importance of co-locating Adult Social Care staff at CoLab, and officers confirmed they were exploring this possibility.

Care Direct Plus, Barnstaple Site Visit

The committee noted the report on the visit to Care Direct Plus in Barnstaple. Members reflected on the pressures facing frontline social care teams, including high caseloads and increasing complexity. Officers highlighted improvements in triage pathways and digital access but acknowledged challenges related to recruitment and rural service delivery. The removal of Pinpoint, a directory of community services, was raised as a point for further exploration.

Health and Adult Care General Update

The committee considered a joint report providing updates on various aspects of adult social care and public health. Discussions covered ongoing pressures, financial constraints, and winter performance metrics. Officers provided updates on the Living Well in Devon programme, public health prevention initiatives, and workforce development.

Scrutiny Committee Work Programme

Members reviewed potential items for future scrutiny, including ICB governance, supported housing, end-of-life care, homelessness, and oversight of transformation programmes. A session was scheduled for committee members to focus on the work programme.

Champion Against Domestic & Sexual Violence and Abuse (DSVA)

Councillor Dawson provided an update on the implementation of the Safe Lives, Strong Communities 2026–29 programme, highlighting multi-agency approaches, early intervention, support for victims, and improved risk identification. Work to enhance workforce training, address digital exclusion, and engage with community organisations was also mentioned.

Information Previously Circulated

The committee noted various pieces of information previously circulated, including the Health & Adult Care Scrutiny Committee Risk Register, updates on safeguarding adult reviews, mental capacity, self-neglect, and information on integrated adult social care site visits.