The Health and Adult Social Care Select Committee met on Thursday 3 July 2025 to discuss a range of critical issues affecting health and social care services in Buckinghamshire. Key discussions included updates from the Integrated Care Board (ICB), Buckinghamshire Healthcare NHS Trust, and Adult Social Care and Public Health departments, alongside the development of Integrated Neighbourhood Teams (INTs). Decisions were made regarding the committee's work programme and the date of the next meeting.

Integrated Care Board Update

Matthew Tate, Chief Delivery Officer for the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB), provided an overview of the ICB's role and recent changes. Established in July 2022, the ICB has undergone significant restructuring, including plans to reduce running costs by 30% and staffing costs by 50%. The ICB's core function is the commissioning of healthcare services with a budget of approximately £3 billion for a population of nearly 2 million. Tate highlighted progress in reducing elective long waits, developing community diagnostic centres, and strengthening out-of-hospital services. He also detailed the proposed merger with Frimley ICB to create a Thames Valley Integrated Care Board. Concerns were raised about the uncertainty surrounding future changes and the potential impact on current commissioning, with assurances given that efforts are being made to minimise disruption. The ICB is also exploring the integration of Artificial Intelligence (AI) into its services, with Buckinghamshire Healthcare NHS Trust being at the forefront of some AI management work, particularly within the cataract pathway.

Buckinghamshire Healthcare NHS Trust: Key Priorities and Challenges

Neil Macdonald, Chief Executive of Buckinghamshire Healthcare NHS Trust, and Jenny Ricketts, Interim Chief Nurse, presented an overview of the Trust's priorities and challenges. Despite significant financial pressures and industrial action, the Trust celebrated milestones such as the 80th anniversary of the National Spinal Injury Centre and the opening of a new 21-bed ward. Operationally, the Trust has seen increased demand for emergency services but has reduced waiting times, ranking highly nationally for Emergency Department performance. The Trust is focusing on improving patient experience, with AI-generated tools being used to analyse feedback. Staff survey results indicated high engagement and morale, with the Trust being in the top 25 nationally for these metrics. Financially, the Trust is facing a contraction in income, leading to a reduction in its workforce, primarily in non-clinical roles. Capital investment is planned for digital transformation and the redevelopment of the Wycombe hospital site. The Trust's new 10-year strategy, developed in anticipation of the national 10-year NHS plan, focuses on integrating care, prevention, addressing health inequalities, and supporting colleagues.

Adult Social Care and Public Health: Key Priorities and Challenges

Councillor Isobel Darby, Cabinet Member for Health and Wellbeing, Craig McArdle, Corporate Director for Adults and Health, and David Munday, Director of Public Health, outlined the key priorities and challenges for their departments. The Adult Social Care budget for 2024/25 was £197.08 million, with a savings target of £9.7 million for 2025/26. Key challenges include managing increasing demand, particularly from those with complex needs and depleted self-funders, and workforce shortages, exacerbated by high housing costs in the south of the county. The department is focused on prevention, promoting independence, and ensuring diversity and inclusion in its services. The Adult Social Care Transformation Programme aims to improve outcomes, customer experience, and service sustainability. Public Health works collaboratively to improve population health and tackle health inequalities, with a net budget of £25.91 million for 2024/25. A significant concern raised was the rising demand for adult social care, with approximately 3,400 contacts received monthly. Strategies to manage this include improving information and advice, prevention initiatives, risk stratification, and the use of new technologies like AI. The Multi-Agency Safeguarding Hub (MASH) is working to address high safeguarding concerns. The CQC report on Adult Social Care is expected to be published on 18 July 2025.

Integrated Neighbourhood Teams (INTs)

Gemma Thomas, Director of Strategy at Buckinghamshire Healthcare NHS Trust, Bobby Pozzoni-Child, Director of Partnership and Transformation, and Nicola Newstone, Assistant Director for Partnership Development, presented on the development of Integrated Neighbourhood Teams (INTs). INTs are designed to bring together professionals from health, the council, and the voluntary sector to provide coordinated, preventative care closer to home. The model is aligned with the Buckinghamshire Health and Wellbeing Strategy, aiming to improve population health, reduce health inequalities, and ensure service sustainability. The development of INTs is seen as a cornerstone for delivering this strategy, with a focus on co-location of services and working with Primary Care Networks (PCNs). Challenges include ensuring adequate financing for these teams and addressing geographical spread in some neighbourhoods. The committee expressed interest in participating in future engagement events related to INT development.

Work Programme and Next Meeting

The committee reviewed and agreed on items for its future work programme. Key topics to be discussed at the next meeting on Thursday 2 October 2025 include the System Winter Plan, the CQC report on Adult Social Care, and a review of Dementia Services. The date of the next meeting was confirmed as Thursday 2 October 2025 at 2 pm.

Decisions Made

• Councillor Shade Adoh was appointed as Vice-Chair of the Health and Adult Social Care Select Committee.
• The minutes of the previous meetings held on 27 February 2025, 6 March 2025, and 21 May 2025 were confirmed as accurate records.
• The committee agreed to the proposed work programme and the date of the next meeting.

Key Discussions and Points Raised

• Integrated Care Board (ICB): Concerns were raised about the uncertainty surrounding the ICB's restructuring and its potential impact on commissioning. The integration of AI was highlighted as a key area of development.
• Buckinghamshire Healthcare NHS Trust: The Trust is facing financial challenges but has made progress in operational performance and patient experience. A new 10-year strategy focuses on integrating care and prevention.
• Adult Social Care and Public Health: Rising demand, workforce shortages, and the need for prevention were identified as key challenges. The department is implementing a transformation programme to improve services and outcomes.
• Integrated Neighbourhood Teams (INTs): The development of INTs is a priority for delivering coordinated care closer to home. Challenges include funding, geographical spread, and ensuring alignment between different organisations.
• Day Opportunities and Overnight Respite Care: The consultation on Better Lives in Our Community proposals for day opportunities and overnight respite care is ongoing, with a decision expected later in the year. Carers expressed significant concern about the uncertainty and the potential impact of any changes.
• Support for Unpaid Carers: The council is developing a new carers strategy and working with partners like Carers Bucks to provide support, including signposting to resources and initiatives like a new carers library card.
• Care Homes: The increasing number of luxury care homes was noted, with questions raised about provision for those who cannot afford private care and the council's oversight of the market.
• Artificial Intelligence (AI): The potential of AI in healthcare and social care was discussed, with a call for a dedicated AI strategy in Adult Social Care.
• Metrics and Outcomes: The committee discussed the importance of robust metrics to measure the success of services, particularly in relation to reablement and ensuring that reported outcomes do not mask unmet needs or increased burdens elsewhere.
• Women's Health Hubs: The existence and development of women's health hubs in Buckinghamshire were questioned, with a commitment to clarify this with ICB colleagues.
• Staff Recruitment and Retention: The challenges of recruiting and retaining staff, particularly social workers, due to high housing costs were discussed. The committee explored whether the council could reframe its offering to make Buckinghamshire a more attractive place to work.
• Consultation Processes: Concerns were raised about the handling of the Better Lives in Our Community consultation, with suggestions that clients and families were informed before councillors, and that the decision-making process was being unduly prolonged.