The Health and Adult Services Scrutiny Committee met on 24 September 2025 to discuss the outcome of a Care Quality Commission (CQC) assessment of adult social care services, which resulted in a Requires Improvement rating. The committee also debated the proposed reconfiguration of NHS vascular services, ultimately deciding it constituted a significant service change requiring public consultation.

CQC Local Authority Assessment Update

The committee received an update on the Care Quality Commission's (CQC) assessment of Lancashire County Council's adult social care services, which resulted in an overall rating of Requires Improvement. Mairead Gill-Mullarkey, Director of Operations for Adult Social Care, and County Councillor Graeme Dalton, Cabinet Member for Adult Social Care, presented the findings.

While the rating was disappointing, the CQC acknowledged positive aspects, including a committed workforce, effective safeguarding systems, and strong advocacy services. Strengths in strength-based service delivery and timely access to support were also noted. However, areas for improvement identified by the CQC included ensuring equity and consistency across all localities, building stronger partnerships with NHS and voluntary sector partners, developing a more sustainable workforce, reducing reliance on agency costs, and improving the timeliness of assessments and reducing waiting lists.

Since the CQC report in February 2025, significant actions have been taken. An Adults Improvement Board, chaired by an independent individual, has been established to oversee the CQC Improvement Plan. Measurable improvements have already been seen, including a 50% reduction in delays to assessments under the Care Act 2014, a 48% reduction in waiting lists for older people and those with physical disabilities, and an 8% increase in the number of annual reviews completed. Recruitment of social workers and occupational therapists has also improved significantly.

Councillor Dalton highlighted that the issues identified were primarily structural rather than related to staff. He emphasised the positive impact of a new strength-based approach within the Customer Access Portal (CAS), which focuses on what individuals can do rather than what they cannot.

The committee was asked to agree to recommendations, including receiving the report, considering the establishment of a member-led cross-party oversight group to monitor improvements, and working on a programme for the oversight of these improvements.

During the discussion, members raised questions about recruitment gaps, equitable access to services across the county, and the sustainability of care workers. It was confirmed that recruitment had improved, with only one occupational therapy vacancy remaining, and that market management strategies were in place to support care providers. The committee also discussed the importance of professional autonomy for social workers and the potential for neighbourhood health initiatives to improve local care delivery.

The committee resolved to consider establishing a task group for further oversight and scrutiny of the CQC action plan and to request more in-depth population health data for future meetings.

NHS Vascular Services Clinical Reconfiguration

The committee discussed the proposed reconfiguration of NHS vascular services within the Lancashire and South Cumbria region. Dr Andy Curran, Associate Medical Director for NHS Lancashire and South Cumbria ICB, Dr Steve Canty, Divisional Medical Director for Surgery at Lancashire Teaching Hospitals NHS Foundation Trust, and Beth Goodman, Associate Director of Planned Care for NHS Lancashire and South Cumbria ICB, presented the proposal.

The proposal involves centralising inpatient arterial services at Royal Preston Hospital¹. This move is intended to improve clinical outcomes by concentrating complex cases in a centre of excellence, enhance workforce sustainability, and align with national standards. The reconfiguration is expected to affect approximately 670 patients annually and will enable better access to specialist support and rehabilitation services. Royal Preston Hospital was chosen as the centralisation site due to its integration with major trauma services and its ability to meet the population thresholds required for specialist vascular care, as recommended by national guidelines. Outpatient, day case, and diagnostic services will continue to be delivered at local facilities.

Members raised concerns about the potential impact on patients in more rural areas, particularly regarding transport difficulties to Preston. It was confirmed that emergency transport would be coordinated with the North West Ambulance Service (NWAS), and that while routine patient transport would still be available, the additional costs for relatives visiting patients were not explicitly factored in. The committee also discussed the risks associated with the reconfiguration, acknowledging both clinical and personal risks related to travel and access.

A key point of discussion was whether the proposed changes constituted a significant service change that would necessitate formal public consultation. After considerable debate, the committee voted by a majority that it did constitute a significant service change and therefore required public consultation.

The committee resolved that the proposed reconfiguration of vascular services constitutes a substantial service variation and therefore requires formal public consultation. They also requested a report detailing the outcomes and impacts of the previous service relocation when Blackpool vascular services moved to Royal Preston Hospital in 2013, including pre- and post-move data and patient experience.

Report of the Health Scrutiny Steering Group

County Councillor Hamish Mills presented a report on the Health Scrutiny Steering Group meeting held on 9 July 2025. The report covered the Steering Group's Terms of Reference and a summary of Health and Care Updates across Lancashire.

A key point raised was the need for improved and more consistent communication from individual NHS Trusts regarding their changes and updates. To address this, the Steering Group requested that individual Trusts be invited to future meetings to provide their updates. Additionally, the Steering Group requested a report on the NHS 10-year plan to help members understand long-term strategic priorities and their implications for local service delivery.

The committee resolved to receive the report of the Health Scrutiny Steering Group.

Health and Adult Services Scrutiny Committee and Steering Group Work Programmes 2025/26

County Councillor Hamish Mills also presented the draft work programme for the Health and Adult Services Scrutiny Committee and Steering Group for 2025/26. This report followed a work planning session held on 25 June 2025. Key upcoming items include discussions on winter planning, a joint annual report from the NHS Northwest Ambulance Service and adult services, and school nursing and early years. The committee noted that the work programme is a live document and can be reviewed and amended at each meeting.

The committee resolved to note the Health and Adult Services Scrutiny Committee and Steering Group Work Programme 2024/25.