The Adult Care and Public Health Scrutiny Committee met to discuss the Integrated Lifestyle Service, the Adult Social Care Strategy, the Adult Social Care Target Operating Model, and service level performance. The committee agreed to support the recommendations to the executive regarding the Adult Social Care Strategy. Members also requested more information on smoking quit targets and discussed the committee's work programme, agreeing to add an extra meeting in March.

Integrated Lifestyle Service Performance Update

The Integrated Lifestyle Service (ILS), known locally as One You Lincolnshire, was a key focus of the meeting, with the committee considering evidence to inform future decisions about the service and wider health improvement priorities. Professor Derek Ward, Director of Public Health, explained that the ILS offers voluntary support for residents wanting to improve their health behaviours, such as quitting smoking, eating well, increasing physical activity and reducing alcohol consumption.

The committee heard that the existing contract for the ILS was coming to an end, providing an opportunity to review the service. A public consultation was underway, and a report on future options would be presented to the executive in February, with the committee reviewing it in January.

Key points from the report and discussion:

• Service Reach: Over the past five years, the ILS has supported 75,000 people in Lincolnshire, with 50,000 achieving positive outcomes.
• Funding: The service is primarily funded through the public health ring-fenced grant, costing just over £3 million annually, supplemented by contributions from the NHS and the Department of Health and Social Care (DHSC).
• Integrated Approach: The ILS's integrated approach allows individuals to address multiple health behaviours simultaneously.
• Smoking: Smoking was identified as the most harmful legal behaviour, significantly reducing healthy life expectancy and increasing the risk of chronic diseases.
• Impact Assessments: Impact assessments for the ILS existed and would be reviewed after the public consultation, with findings presented to the committee in January.
• Weight Management: Weight management services, delivered in partnership with Slimming World and Weight Watchers, have largely returned to face-to-face sessions.
• Vaping: Vaping is addressed within smoking cessation efforts as a harm reduction strategy, with smokers encouraged to switch to vaping as a safer alternative. A separate schools programme targets vaping prevention among young people.
• Demand for Social Care: The ILS helps reduce demand for adult social care, with smoking cessation potentially delaying the need for social care by up to 10 years. The service also includes a falls prevention programme for older adults.
• Smokefree Generation Grant: Continued receipt of the £1.14 million Smokefree Generation grant from the DHSC depends on maintaining current levels of investment in smoking cessation services.
• NHS Contributions: NHS contributions were understood to be committed if the ILS continued.

Councillor James Bean raised the issue of substance misuse, suggesting that the ILS could play a role in early intervention to prevent progression to severe addictions. Andy Fox, Consultant in Public Health, agreed, stating that intervening early with addictive behaviours was more cost-effective.

Councillor Karen Elizabeth Lee requested clarification on impact assessments, asking if they had been prepared and not given to the committee, or if they had not been completed. She also asked if impact assessments were legally required before decommissioning a service, to avoid judicial review. Professor Derek Ward confirmed that an impact assessment had already been done and would be updated with the outcome of the consultation.

Councillor Robert Jozef Kendrick raised concerns about weight management services, suggesting that during Covid restrictions, the telephone based service was open to abuse. Professor Derek Ward clarified that the service is now largely face-to-face.

Councillor Mrs Jane Smith asked if vaping would be included under the anti-smoking health service, as it seems that youngsters seem to be starting at quite an early age vaping. Professor Derek Ward confirmed that if somebody is smoking tobacco, One New Lincolnshire will help them to make that switch to a nicotine vape, but the advice from public health is that if somebody doesn't smoke, they shouldn't start vaping.

Councillor Kelham Cooke asked how the ILS features in long-term demand management modelling for adult social care. Professor Derek Ward responded that the area that has been analysed is around smokers needing care services 10 years earlier than non-smokers.

Councillor Richard James Cleaver asked how the council knows it is putting the right balance of resources into persuading people who don't want to change their lifestyle versus helping those that do want to change. Professor Derek Ward responded that there is strong academic literature out there, but more research is always needed.

Councillor Mrs Susan Woolley asked for reassurance that if the NHS ICB contribution of half a million pounds was taken out, the council would still be including the £500,000, particularly because of the £1.4 million being contingent from DH on the council's amount being put in in the first place. Professor Derek Ward confirmed that the integrated care board are committed for this financial year, and are also committed to carry on if the proposal is to continue with the lifestyle service.

Councillor Richard Stephen Litchfield asked how proactive the service is and how focused it is at preventative measures, mentioning Parkrun as a free concept that introduces a lifestyle change before perhaps it's recognised. Professor Derek Ward agreed that Parkrun is massively beneficial, but the integrated lifestyle service is for people who already have an existing challenge.

Councillor Mrs Marianne Jane Overton MBE asked for more information on how the documents demonstrate the facts that show the value of the outcomes. Professor Derek Ward responded that there was a university research document, and that if the councils are going to be dissolved and new ones started, there will need to be some really good basis for new contracts.

The committee agreed to note the report and pass on their comments to the executive.

Adult Social Care Strategy

The committee considered the Adult Social Care Strategy prior to a decision by the executive in January 2026. Martin Samuels, Executive Director of Adult Care and Community Wellbeing, highlighted that the strategy aims to help Lincolnshire residents maintain independence, reduce the need for adult social care, and ensure sustainable finances. The strategy is guided by the Target Operating Model, which shifts focus from reactive care delivery to preventative and early intervention.

Key points from the report and discussion:

• Revised Document: The strategy document had been significantly revised and shortened to make it clearer and more user-friendly.
• Integrated Care Board (ICB): The council had engaged with the new leadership of the Integrated Care Board (ICB), which had transitioned from a Lincolnshire-only board to a Derbyshire-Lincolnshire-Nottinghamshire cluster.
• Coordination of Services: The Target Operating Model would improve coordination across services by creating a focus on prevention and early intervention.
• Lincolnshire Voice: Lincolnshire would continue to have a clear voice in the ICB cluster, with the previous Interim Chief Executive of the NHS Lincolnshire ICB appointed Director of Strategy and Customer Engagement for the cluster.
• Performance Indicators: The impact of the proposed Adult Social Care Strategy would be measurable through the development of the new Council Plan, which would include performance indicators.
• Direct Payments: The proportion of adults in receipt of Direct Payments (DPs) had fallen below the target of 42%. The service was reflecting on whether some individuals were benefitting from their DP, to ensure that the DPs continued to be effective.

Councillor Christopher John Reeve asked about an incident at Boston Pilgrim Hospital where a patient was given an eviction notice for refusing to leave. Martin Samuels responded that people don't have a right to be in hospital, and that Lincolnshire does really well in terms of very few people having to wait more than a few days for care packages to be arranged.

Councillor James Bean asked how the Targeted Operating Model is actually going to improve the coordination amongst services across the county. Martin Samuels responded that the main issue is that the staff across the directorate are being spoken to about the target operating model, getting that way of thinking about prevention and early support and early early action.

Councillor Karen Elizabeth Lee said that in her 25 years working in hospitals, she had never known anyone refuse to go home. Martin Samuels responded that if a care package has been offered and it's in place, or if it's been offered and declined and they've got capacity, they have to go because hospitals are not hotels.

Councillor Kelham Cooke asked how the council will ensure this cultural shift is consistently implemented across teams, especially given the CQC's previous findings around variability in practice and decision making. Martin Samuels responded that there will be an ongoing engagement with staff to emphasize that prevention is better than cure, and that the issue of variability is where performance management comes in.

Councillor Mrs Susan Woolley referred to the proportion of adults who receive direct payments in this paper, and said that in a later paper, the committee will be discussing performance, and in this previous set of figures, the council should be aspiring to beat that. Martin Samuels responded that there is no change in the philosophy that direct payments in the right circumstances are a good thing.

The committee agreed to support the recommendations to the executive and pass on their comments for consideration.

Adult Social Care Target Operating Model (TOM) and Staff Realignment Update

Hayley Eccles, Deputy Director of Adult Social Services, presented an update on the Adult Social Care Target Operating Model (TOM) and staff realignment. The TOM provides a framework for delivering Care Act duties through early intervention, technology-enabled support, and integrated working with partners and stakeholders.

Key points from the report and discussion:

• Core Purpose: The TOM's core purpose is to maximise independence, strengthen resilience, and keep people in their own homes and communities for as long as possible.
• Operational Teams: Operational teams have been reorganised into area-based teams aligned to local communities.
• Leadership Structure: A streamlined leadership structure has been implemented.
• Learning Disability Team: The learning disability team has been amalgamated into the three area teams, resulting in improved service delivery, reduced waiting times, and better staff morale.
• Next Steps: The next steps of the TOM include developing 'pre-front door' and 'early front door' approaches to intervene earlier, prevent deterioration and signpost closer to communities.
• Statutory Services: The TOM also aims to ensure people enter adult social care at the right time and enables them to step back into less restrictive services when their outcomes are met.

Councillor Richard James Cleaver asked what the council is doing to develop a greater understanding of those people that are digitally excluded, and what it is going to do to help them. Hayley Eccles responded that the council is speaking to people and co-producing solutions, and that there will always be some people who cannot access digital or digitally excluded, so the council needs to be proportionate and meet the needs of all of its communities.

Councillor James Bean said that he would be happy if he got a one g out there, referring to the poor internet signal in his ward.

Councillor Maggie Cullen asked what the predicted costs are, and if the council predicts any cost savings in social care. Hayley Eccles responded that with transformation and becoming more effective and efficient, either the needs are met in a more cost effective way, or that the need never arises.

Councillor Karen Elizabeth Lee thanked Hayley Eccles for a really comprehensive report, and said that she was pleased to see the direction of travel.

Councillor Mrs Marianne Jane Overton MBE asked what is new here, and how she can be convinced that this is really a step change. She also asked about the impact on unmet need, and if the council is just delaying the cost. Martin Samuels responded that it will have a significant impact on the people of Lincolnshire, and that the focus of what the council is trying to do is to avoid the need arising.

Councillor Kelham Cooke asked how the TOM future proofs the capacity to deliver both the statutory duties and also the early intervention ambitions at the heart of this new approach. Hayley Eccles responded that the council is deciding who is best placed to deliver the meals on wheels service, and that the time window within which the meal gets delivered is a really narrow one.

The committee agreed to note the report.

Service Level Performance Reporting

Martin Samuels presented a report summarising the service level performance of adult care against the performance framework 2025-26 as at quarter two. He highlighted key successes, including the proportion of people remaining at home 91 days after hospital discharge, the reablement service, safeguarding performance, and direct payments. He also noted an area for improvement: annual reviews of long-term support.

Key points from the report and discussion:

• Key Successes: The report highlighted successes in areas such as the proportion of people remaining at home 91 days after hospital discharge and the effectiveness of the reablement service.
• Annual Reviews: The report identified annual reviews of long-term support as an area for improvement, with 75% of people in receipt of long-term support being reviewed against a target of 85%.
• Focus on Efficiency: Resources were being focused on individuals where a change in care need seemed most likely, rather than spending large amounts of time reviewing individuals whose care needs were stable.

Councillor Christopher John Reeve said that it seems quite a strange situation that the council has this target of 85, but Martin Samuels is quite comfortable that the council is almost 10 below that because it's actually getting the required outcomes. Hayley Eccles responded that it is really important to have a target, and that the council is performing both with regional but also national neighbors and authorities as well.

Councillor James Bean said that he hears a lot of talk about KPIs and KPTs, and that quite often he has found that they actually get in the way of doing the job effectively. Martin Samuels responded that the KPIs are set based on individual's need, and the individual's need is not limited by the KPIs.

Councillor Mrs Marianne Jane Overton MBE said that if the government arrived and said where are your figures, would the council have a poor rating announced nationally because sometimes these things are just worth doing even though you know you've got other priorities. Martin Samuels responded that he will argue with the CQC if they challenge him on it, that he is of the opinion that the council is focusing on the right people.

Councillor Karen Elizabeth Lee said that she supports what Martin Samuels said about targets, because she thinks the council should always aim up.

Councillor Jimmy William Brookes asked why One New Lincolnshire only achieved 675 successfully quits against the target of 897, and what actions are being taken now to make sure this service improves and meets future smoking quit targets. Martin Samuels responded that the council has been focusing them on the total number of interventions, and that there is always scope for improvement and the council is always looking for it.

The committee agreed to note the report and requested further information on One You Lincolnshire's underperformance on smoking quit targets.

Work Programme

Hannah Colclough, Scrutiny Officer, presented the committee's work programme. The next scheduled meeting is on 7 January 2026, with four scheduled items: externally commissioned buildings based daycare reprocurement, the home-based re-enablement recommissioning, the enhanced technology enabled care services, and the short break service contract extension.

Councillor Karen Elizabeth Lee said that the integrated lifestyle service future arrangements doesn't come back to this committee until the 28th of January, and that she would like those impact assessments at the earliest available opportunity.

Councillor Mrs Marianne Jane Overton MBE suggested that a report on the health impacts of solar industry developments on farmland be brought to the Committee.

Councillor Christopher John Reeve said that he was at a nursing home visit last week, and that this nursing home has managed to get hold of a bladder scanner, but if they have a resident who's under the care of the district health nurse, they are not allowed to use it.

Councillor Maggie Cullen asked if the committee could maybe split the February meeting and have an extra meeting in March.

The committee agreed to review the work program and highlight any additional scrutiny activity which could be included, and to add an extra meeting in March.