The Wiltshire Council Health Select Committee met to discuss several key issues, including updates on the Integrated Community Based Care contract, the implementation of the dementia strategy, and the future commissioning of community-based services. The committee also addressed public questions about NHS privatisation and the role of Integrated Care Boards¹ (ICBs).

Public Participation

The committee addressed two questions submitted by Chris Caswell regarding the Integrated Community Based Care contract with HCRG and the role of the Banes, Swindon and Wilter ICB. Mr Caswell raised concerns about the assertion that the HCRG contract is not a privatisation of the NHS, given HCRG's status as a private company owned by a private equity firm, Twenty20 Capital. He also questioned why the reorganisation and resource reduction of the ICB was not included in the committee's work programme.

The committee responded that the minutes accurately reflected discussions and that the impact of ICB changes would be considered as part of ongoing scrutiny.

Amesbury Pharmacy Provision

Councillor Dr Monica Devendran raised an urgent item regarding the need for an additional pharmacy in Amesbury. She stated that despite clear demand and feedback from residents, a recent application to open a pharmacy was rejected. Councillor Dr Devendran urged the committee to formally note her comments and pass them on to the Health and Wellbeing Board, requesting a revisit of the decision to ensure the framework allows for an additional pharmacy in Amesbury. Councillor Clare Cape, Cabinet Member for the NHS, offered her support and requested to be copied on the letter to the Health and Wellbeing Board.

Integrated Community Based Care Contract Update

The committee received an update on the Integrated Community Based Care (ICBC) contract with HCRG Care Group Ltd. Caroline Holmes, Interim Executive Director of Place for Wiltshire, and Val Scrase, Regional Director for HCRG, presented the report. The discussion focused on the impact of transformation on services and the neurodiversity pathway.

Key points:

• Transformation Programme: HCRG is in the process of discovering and understanding current services, engaging with communities and service users to identify areas for improvement. By the end of March, key programmes will be delivered, including a digital front door, a single point of access and a care coordination centre, and a neighbourhood health model.
• Co-production: An example of person-centred transformation was given relating to youth feedback on terminology for the digital front door, with young people suggesting the use of QR codes in places like police stations.
• Digital Access: The committee discussed how people will know about the digital door, particularly older people. It was confirmed that work is underway to ensure connectivity with acute trusts and to increase the use of NHS apps.
• Communication: It was agreed that consistent communication across the local authority and health providers is essential, and local councillors offered to share information through area boards and social media.
• Outcomes Framework: The committee discussed how outcomes are measured, with a focus on ensuring people only need to tell their story once. Councillor Ed Rimmer was interested in how this is measured specifically, and to what extent data on that and anything else can be measurable on a Wiltshire specific level. It was agreed that listening to service users and looking at case studies is crucial.
• Neurodiversity Pathway: Laura Ambler, Executive Director of Place for Bains, provided an update on the transformation of provision for children and young people with neurodivergent ADHD and autism traits. The committee heard that there was a need to improve transitions between children and young people in adulthood, and to consider what might be done around waiting times, particularly for those adults with ADHD.
• Promoting Inclusivity in Schools (PINS): Val Scrase explained that the PINS programme is working with schools to help them understand what's in their power to change, either through teaching differently, around some of the interventions, or by changing the environment in which they're teaching.
• Need Led Referrals: Referrals are now based on the impact of neurodiversity rather than severity, with a focus on parental or school referrals.
• Waiting Well Provision: Councillor Sam Blackwell highlighted that the waiting well provision was a source of anxiety among parents.

The committee requested that HCRG return in November to talk about both of these areas, and to provide anonymised case studies.

Dementia Strategy 2023-2028 Update

The committee received an update on the implementation of the Dementia Strategy 2023-2028 from Alison Elliott, Director of Commissioning, and Victoria Bailey, Head of Adults Commissioning. The discussion covered supporting people, engagement in the community, and differential diagnosis rates.

Key points:

• Dementia Diagnosis Rates: Wiltshire's diagnosis rate is 63.8%, slightly below the national target of 66.7%. Work is underway to improve diagnosis rates through GP practices and support from Avon and Wiltshire Mental Health Partnership[^3] (AWP). [^3]: Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) provides mental health services across Bath and North East Somerset (BaNES), Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire.
• GP Involvement: Most GP practices in Wiltshire have signed up to a locally commissioned service to encourage dementia diagnosis.
• Alzheimer's Support Subsidies: A question was raised about the sustainability of Alzheimer's Support subsidising commissioned services. It was agreed that this would be considered as part of the contract review.
• Data Collection: The committee requested figures on the percentage of diagnoses made by GPs versus memory clinics, and whether there is a difference in the specificity of diagnoses provided by each.
• Dementia Advisor Service: Councillor Chuck Berry questioned the diversity in referral numbers across different areas and how to standardise the service.
• Data Sources: Alison Elliott explained that a multitude of data sources are used to make predictions, including the Joint Strategic Needs Assessment[^4] (JSNA) and national data sources. [^4]: Joint Strategic Needs Assessments (JSNAs) are carried out by local authorities and clinical commissioning groups to assess the health and wellbeing needs of a local population.
• Cases Closed: The committee asked for a breakdown of why cases are closed, including deaths and transfers to nursing care.
• Carers Champions: The committee discussed the potential of setting up a new system of carers champions and support champions for different areas.
• Contract Renewals: The committee discussed the timelines for contract renewals with Alzheimer's Support, with a decision expected by the end of the year.

The committee resolved to receive information from the ICB and internal staff on dementia diagnosis rates and equity of provision.

Future Commissioning of Community Based Services

The committee reviewed a proposal for the future commissioning of community-based services, as the report was due to be considered by Cabinet on 16 September 2025. Councillor Gordon King, Cabinet Member for Adult Social Care, introduced the paper.

Key points:

• Strategic Direction: The proposal recommends recommissioning all community-based services in Wiltshire via a single joint framework covering adults and children.
• Co-production: Extensive co-production and consultation with service users and carers has been completed.
• Pressures: Wiltshire is experiencing significant population growth in the over 65s and over 85s, and there is over saturation in the home care market.
• Frameworks: The emerging preference is to combine three different frameworks into a single framework.
• Service Types: The framework will cover home care, supported living, individual service funds, extra care, living care, and trusted assessors and reviewers.
• Geographical Areas: The county will be broken down into 21 towns to support purchasing by smaller geographical areas.
• Integration: The new framework aims to integrate adult and children's services, with consistent quality standards and contract terms.
• Self-funders: Councillor Chuck Berry raised the issue of interspersed self-funders and how to make it easier for commissioned companies to access them.
• Care Act: Alison Elliott confirmed that the council has a statutory responsibility to support residents who are unable to fund their own care under the Care Act 2014.

The committee provided feedback for Cabinet to consider.

Cabinet Member Updates

• Councillor Gordon King announced a series of roadshows around the county to engage with current and potential users of adult social care services.
• Councillor Clare Cape highlighted a Gypsy, Roma, Traveller and Boater event in Wiltshire in autumn, focusing on digital technology access, and thanked Fair Sabre Buses for providing free travel on 999 day for emergency services staff.

Forward Work Programme

The committee reviewed the forward work programme and discussed scrutinising the impact of the overspend in the adult social care budget in 2024/25. Alison Elliott assured the committee that statutory responsibilities to meet people's needs are being met and that people are not experiencing any detriment as a result of the financial circumstances.