The Health and Adult Social Care Overview and Scrutiny Committee of Cornwall Council met on Wednesday 15 July 2026 to discuss the Care Quality Commission's (CQC) inspection report, Integrated Care Board (ICB) updates, and vaccination programmes. The committee welcomed the council's 'Good' rating from the CQC and discussed plans for continuous improvement, while also expressing concerns about a potential merger of the Cornwall and Isles of Scilly ICB with Devon ICB.

Care Quality Commission (CQC) Local Authority Inspection Report and Continuous Improvement Plan

The committee welcomed the outcome of the Care Quality Commission (CQC) assessment of Cornwall Council's adult social care services, which resulted in an overall 'Good' rating. The inspection, which took place in June 2025 and was published in May 2026, highlighted strengths in person-centred practice, safeguarding, and commissioning, while identifying areas for further development such as timeliness and consistency of service delivery. The committee expressed assurance in the council's response to the findings, including the development of a Continuous Improvement Plan, and supported its ongoing oversight of this plan.

The Strategic Director for Care and Wellbeing expressed pride in the authority's achievement, thanking committee members, officers, partners, providers, and residents for their contributions. The report detailed the inspection process, which involved documentation review, performance data analysis, interviews, and engagement with service users and carers. Strengths identified included person-centred practice, strengths-based approaches, safeguarding, prevention, commissioning, co-production, and learning from feedback. Areas for improvement included timeliness, consistency of service delivery, equitable access, reasonable adjustments, embedding safeguarding learning, and strengthening feedback arrangements with partners.

Members congratulated officers and staff on the 'Good' rating, acknowledging the significant work undertaken. Officers explained that this was the first assessment under the revised CQC framework. They noted that the findings largely reflected issues already identified through the council's existing governance and performance arrangements. A Continuous Improvement Framework was proposed, focusing on timely and equitable access to support, consistent quality and safeguarding practice, preventative and strengths-based support, workforce development, and governance arrangements.

Regarding safeguarding, officers confirmed the report was largely positive, with areas for improvement relating to evidencing learning from incidents, sharing learning with partners, and improving feedback following safeguarding referrals. They clarified that the inspection focused on adult safeguarding arrangements for those aged 18 and over, with approximately 10,000 safeguarding concerns received annually. Officers stated that it was preferable for concerns to be over-reported rather than under-reported.

Members questioned the delay between the inspection and the report's publication, which officers attributed to national workforce and capacity challenges within the CQC and the rollout of the new inspection programme. Assurances were sought regarding the authority's current position and future trajectory, with officers expressing confidence in the service's strong performance despite ongoing demand pressures. They reaffirmed their commitment to continuous improvement, irrespective of the inspection outcome. Future CQC assurance arrangements will involve ongoing engagement and annual discussions, with reassessments being intelligence-led.

Concerns were raised about delays in accessing services, with officers reporting significant improvements in reducing waits for assessments and services. Delays relating to occupational therapy assessments, Deprivation of Liberty Safeguards (DoLS), and care reviews were highlighted, with improvement work already underway and exploration of digital solutions and self-service options. Members acknowledged and thanked frontline care staff, carers, and providers for their dedication. The importance of wider council services, including housing, transport, and community wellbeing, in contributing to social care outcomes was also discussed, emphasizing the need for a coordinated council-wide approach.

The committee resolved to welcome the CQC inspection outcome, take assurance from the council's response and continuous improvement approach, and provide its views on the proposed continuous improvement framework.

ICB Cluster Update

The committee discussed the current cluster arrangements of NHS Devon and NHS Cornwall and Isles of Scilly Integrated Care Boards (ICBs), the proposed future footprint, and progress towards a potential merger. Officers confirmed that the ICB had submitted its response to NHS England regarding future ICB footprints, following engagement with stakeholders. The ICB Board's position was to support the continuation of the Cornwall and Isles of Scilly and Devon footprint, with a likely merger anticipated from April 2027, subject to national decisions.

Members sought clarification on whether a merger was a foregone conclusion, with officers advising that while a merger was considered likely, the immediate decision concerned the footprint. National decisions would be required before any merger could proceed. NHS England had mandated significant reductions in ICB running costs nationally and identified a minimum population threshold of approximately two million for future ICB arrangements, which Cornwall and the Isles of Scilly alone would not meet.

Concerns were raised about local opposition to a merger and whether these views would be given sufficient weight. Members requested a copy of the full submission made to NHS England, which officers undertook to consider. It was noted that Cornwall Council representatives sat on the ICB Board and had access to relevant board papers. Members reiterated concerns that Cornwall's innovation and neighbourhood working could be diluted within a larger organisation, though officers stated that Cornwall and the Isles of Scilly had been recognised nationally for their leadership in neighbourhood health initiatives.

Clarification was sought regarding the impact of the proposed NHS Modernisation Bill, with officers advising that the current focus was solely on footprint decisions and that discussions regarding future governance structures remained speculative. Members expressed concern about potential changes to local authority representation on future ICB Boards and the implications for democratic accountability, acknowledging that proposed legislation created uncertainties.

The timing of the NHS England submission and the possibility of meaningful scrutiny were questioned, with officers explaining that the submission timetable had been set nationally and engagement had been undertaken at pace. Distinction was sought between existing cluster arrangements and a future merged organisation, with officers confirming that Cornwall and Isles of Scilly ICB and Devon ICB remained legally separate organisations operating within a cluster.

Members reiterated concerns that Cornwall could become disadvantaged within a larger organisation and maintained their preference for retaining a sovereign Cornwall and Isles of Scilly ICB. Officers clarified that financial support for Devon's recovery was being provided through regional and national NHS funding and was not being funded from Cornwall allocations. Members requested continued transparency and information regarding financial arrangements and any future impacts arising from cluster or merger proposals.

The committee resolved to note the report on the cluster arrangements, the NHS England consultation on footprints, and the engagement that had taken place. It requested a copy of the ICB's reply to NHS England regarding the geographic footprint merger and reiterated concerns about a merger, expressing a preference for a sovereign Cornwall and Isles of Scilly ICB, and resolved to continue monitoring developments.

Vaccination and Immunisation Programmes Update, Adults and Children

The committee received an update on vaccination and immunisation programmes across Cornwall and the Isles of Scilly. Local vaccination uptake rates were generally at or above the England average across key programmes, including childhood immunisations and seasonal vaccinations for older adults. However, uptake remained below World Health Organization targets, and inequalities persisted among deprived, rural, isolated, and underserved communities. Ongoing outreach work to improve access and reduce inequalities was highlighted, along with the planned transfer of vaccination programme commissioning responsibilities to Integrated Care Boards from April 2027.

Members sought assurance regarding informed consent arrangements, with officers confirming that vaccination providers followed appropriate procedures and that healthcare professionals were aware of their responsibilities for reporting adverse reactions through the national Yellow Card Scheme. The importance of maintaining public trust through transparent communication and robust consent processes was discussed.

Concerns were raised regarding vaccination during pregnancy, with officers advising that communications materials and engagement activities were designed to support informed choice, and that individuals were encouraged to discuss vaccination with healthcare professionals. Changes to the perinatal vaccination pathway provided multiple opportunities for discussion. Examples of public engagement activity were provided.

The Director of Public Health advised that vaccine safety was monitored through robust national systems, including the Yellow Card Scheme and wider national surveillance arrangements, with vaccine safety, effectiveness, and adverse events reviewed continuously. He emphasised that no medication or medical intervention was entirely risk-free but that vaccines underwent rigorous assessment and ongoing monitoring. Informed consent and individual choice remained fundamental principles.

The Chair of the Together for Families Overview and Scrutiny Committee welcomed the strong performance of children's vaccination programmes and acknowledged the positive impact of outreach activities. Information was requested regarding Human Papillomavirus (HPV) vaccination uptake, with officers advising that it remained a priority programme.

Concerns were raised regarding relatively low uptake of flu vaccination among two- to three-year-olds, despite performance being above the national average. Officers outlined initiatives to improve access, including vaccination delivery through early years settings, expansion of community pharmacy provision, and targeted communication campaigns. Positive feedback was provided regarding improvements to the school-based flu vaccination consent process.

Members commented on the wider benefits of vaccination programmes in preventing serious illness and protecting communities, particularly in rural areas. Officers described ongoing efforts to reach rural and isolated communities through targeted outreach clinics and local partnerships. A national pilot involving health visitors delivering vaccinations to underserved families was highlighted, with a suggestion for further exploration of how Public Health Nursing services might support vaccination uptake.

The Chair requested consideration of whether vaccination uptake data could be provided at neighbourhood level to support future scrutiny of health inequalities. Officers agreed to investigate the necessary permissions to share more detailed local data. A question regarding long-term monitoring of infants whose mothers had received the RSV vaccination during pregnancy was reiterated, with officers confirming that RSV vaccination was monitored through the same national safety and surveillance arrangements as other vaccination programmes.

The committee resolved to note the role of vaccination and immunisation, the priority groups and vaccines identified for improvement, and the work underway to reduce inequalities. It also noted the forthcoming transfer of vaccination and screening commissioning to integrated care boards and requested that local neighbourhood data on vaccination uptake be provided to members.

Strategic Direction for Designing Neighbourhood Out-of-Hospital Urgent On-the-Day Care

The committee received a presentation outlining the strategic direction for the redesign of neighbourhood-based urgent on the day care. Current urgent care services were described as fragmented, with multiple delivery models, workforce and financial pressures, and a complex system for patients to navigate. The proposed approach aims to simplify access, improve integration between services, support more sustainable use of workforce and resources, and deliver care closer to home, with engagement with patients, staff, stakeholders, and local communities being a key component.

Concerns were raised regarding access to urgent care services in West Cornwall and why 24-hour urgent care provision was no longer available at West Cornwall Hospital. Officers acknowledged concerns regarding commissioning requirements and delivery, stating that the review would consider local provision, including services at West Cornwall Hospital, and involve providers, stakeholders, patients, and communities in determining future neighbourhood-based models. The work would also consider how best to meet demand outside normal GP opening hours.

Clarification was sought on what urgent on the day care would look like in practice, with members advised that the model was intended for people requiring urgent same-day assessment who did not need emergency department treatment. The types of needs which might be managed through general practice, community pharmacy, urgent dental services, minor injury services, and other community-based provision were discussed. The ambition was for patients to have access to a simpler system, potentially through a single point of contact, enabling them to be directed quickly to the most appropriate service.

Neighbourhood-based service design was expected to help address challenges of consistency of service delivery by bringing providers together to develop integrated models tailored to local needs. It was noted that workforce shortages affected multiple services and that a more integrated approach could support recruitment, retention, and deployment, improving staff morale and professional satisfaction.

The tension between national performance targets and local flexibility in service design was discussed, with the possibility of a period during implementation when national performance measures and local improvement priorities did not fully align. Members expressed support for prioritising improvements in local patient experience, even where this created short-term challenges in achieving national performance metrics.

A representative from Healthwatch asked how the programme would assess whether improvements were genuinely being experienced by patients and frontline staff. It was acknowledged that patient and staff experience would be a crucial measure of success, and neighbourhoods would be expected to continuously review effectiveness.

The committee resolved to endorse the strategic direction toward neighbourhood-based design of urgent on-the-day care, support progression to detailed framework development, neighbourhood engagement, and local model design. It also noted the operational, contractual, financial, and national policy constraints associated with implementation, including the tension between national performance standards and local flexibility, and supported continued engagement with providers, neighbourhoods, and national partners.

Corridor Care, ED Waiting Time, Out of Hospital Urgent Care

The Chief Operating Officer of Royal Cornwall Hospital NHS Trust (RCHT) presented a report on corridor care, emergency department (ED) waiting times, and out-of-hospital urgent care. Despite some improvements in ambulance handover times, performance remained below target, and pressures relating to patient flow and delayed discharges continued to contribute to the use of corridor care. Actions being taken to improve patient flow, reduce delays, and increase discharge capacity were outlined.

It was commented that corridor care remained commonplace and was causing distress and loss of dignity for patients. The Trust remained committed to reducing and eliminating corridor care. Improvement work included reviewing prolonged corridor care episodes, reducing delays relating to discharge medication, discharge summaries, and patient transport, and improving patient flow through same-day emergency care and rapid assessment services.

Members welcomed the actions being taken but emphasised the importance of ensuring that improvements were reflected in patient experience. A query was raised regarding when revised performance targets and timescales would be established, with an updated improvement trajectory being finalised and reported through the Trust's governance processes.

Concerns were raised regarding prolonged ambulance and air ambulance handover delays, with the Trust working with ambulance partners to improve transfer arrangements and minimise delays. A discussion took place on the role of wider system partners in reducing delayed discharges and supporting discharge pathways, with work underway across the health and care system to improve discharge planning, review capacity, and make better use of community services.

Members reflected on a recent visit to the hospital, during which significant operational pressures, ambulance queues, and corridor care had been observed, noting that discharge delays appeared to be a significant contributor to those pressures. The professionalism, compassion, and commitment of frontline staff were commended despite the challenging circumstances. Actions being taken within community and social care services to support timely discharge and improve patient flow were discussed. Members welcomed Healthwatch Cornwall's offer of independent patient experience evidence to inform the work of its forthcoming task and finish group on Hospital Discharge and Flow.

The committee resolved to discuss and consider the actions being taken to end corridor care and improve urgent and emergency care performance. It requested a further update report in six months' time on progress against improvement actions, including performance targets and reducing corridor care. Recommendations will be returned to the committee from its Task and Finish Group on Patient Flow and Discharge working with RCHT and system partners.

Public Questions

One question was received from Mr B Kay from Boscastle regarding 'Social Prescribing Funding'. Mr Kay highlighted the support provided by the Two Bays Trust for Green Social Prescribing and the need for consistent, longer-term financial support. He asked about the level of ICB funding allocated to social prescribing and its accessibility. The Vice Chairman provided an answer from the Cornwall and Isles of Scilly Integrated Care Board, stating that organisations seeking NHS funding would need to engage with relevant commissioning and procurement processes, and that funding decisions must align with NHS commissioning priorities, procurement requirements, and available resources. Mr Kay then cited a study from The Wildlife Trust estimating significant national savings and economic returns from green social prescribing. The Vice Chairman advised that the question could also be asked at the public meeting of the Cornwall and Isles of Scilly (CIoS) Integrated Care Board.

Questions from Members to Cabinet Members on their Updates

The Cabinet Member for Adult Social Care and Health Partnerships highlighted Cornwall's recent CQC 'Good' assessment and noted that a continuous improvement plan and a revised Adult Social Care Transformation Programme were in development. Reference was made to the forthcoming decision on the RISE (Resilience, Inclusion, Strength and Enablement) Project. During discussion, concerns were raised regarding difficulties accessing community pharmacy services, and members were advised that decisions on community pharmacy applications were made by the NHS South West Collaborative Commissioning Hub. It was noted that Integrated Care Board (ICB) representatives would be attending a future meeting. Pharmacy provision was confirmed to fall within NHS responsibilities, although Cornwall Council's Public Health service had a role in assessing local pharmaceutical needs. A Pharmacy Needs Assessment for the ICB had identified reductions in pharmacy provision in St Ives and west Cornwall.

The Cabinet Member of Community Safety and Public Health introduced her report, highlighting ongoing work in relation to dentistry and mental health initiatives. The importance of early intervention, prevention, and partnership working was emphasised. Work arising from the Council's dentistry motion was progressing, including expanded oral health promotion initiatives and consideration of options to improve access to services. Issues relating to the affordability and accessibility of NHS dentistry would form part of discussions at the forthcoming Dentistry Summit. The ICB was seeking to commission additional dental provision to improve access in Cornwall.

In response to questions on neighbourhood arrangements, it was explained that the Council was working closely with NHS partners to develop Integrated Neighbourhood Teams and plans, with a focus on reducing health inequalities. Cornwall Council had an important role in shaping neighbourhood health arrangements through the Health and Wellbeing Board and Committee in Common with NHS partners. The forthcoming Mental Health Annual Report would include targeted recommendations for action. The updates were noted.