The Health and Adult Services Scrutiny Committee met on Wednesday, 10 December 2025, to discuss the use of digital technologies in adult services, the local implementation of the NHS 10-year health plan, and proposed transformations to secondary care orthodontic services. The committee also reviewed its work programme and discussed the ongoing provider services redesign for adult social care.

Use of Enabling Digital Technologies in Adult Services

The committee received a presentation on the use of enabling digital technologies within adult services, focusing on current pilots and future plans. Mairead Gill-Mullarkey, Director of Operations for Adult Health and Wellbeing, and Pete Lloyd, Director of Digital Services, outlined how technology, including Artificial Intelligence (AI), is being used to improve care delivery, enhance efficiency, and support social care staff.

Key initiatives discussed included the rollout of the Nourish app in 16 residential care homes, the introduction of the Nobi Smart Lamp to detect falls, and the deployment of Copilot AI to assist practitioners with tasks such as case prioritisation and report writing. The report highlighted the ambition to empower residents and their carers through digital tools, improve the digital capabilities of the workforce, and foster better connectivity within the care sector.

Councillor Mark Jewell welcomed the report but raised concerns about data assurance and the potential for AI to become a barrier to face-to-face advocacy for complex cases, particularly for vulnerable individuals who may not have access to digital devices. He stressed the importance of ensuring that digital solutions do not disadvantage those who are digitally excluded. Councillor Jewell also appealed for investment in ensuring data accuracy.

Pete Lloyd assured the committee that AI is being used as an assistant rather than a decision-maker, and that safeguards are in place, including ethical oversight and data protection measures. He acknowledged the ongoing journey of data quality improvement across the council.

Councillor Iqbal questioned the meaning of empowered in the context of vulnerable individuals and asked how the Scrutiny Committee would monitor progress. Mairead Gill-Mullarkey explained that empowered means providing individuals with more tools and control over accessing services, citing the video relay service for deaf individuals as an example. The committee discussed various methods for monitoring progress, including receiving updates and potentially hearing from frontline staff.

Concerns were also raised about the impact of digital transformation on the workforce, with Councillor Iqbal asking how staff would be reassured that their jobs would not be threatened. Helen Coombs, Interim Executive Director for Adult Health and Wellbeing, explained that the focus is on using technology to enable staff to spend more time with residents and improve efficiency.

The committee agreed to note the approach proposed in the report and to monitor progress, with a suggestion that frontline staff and social workers be invited to future meetings to share their experiences.

10 Year Health Plan - Local Challenges and Opportunities

Jane Cass, Director of Partnerships and Collaboration for Lancashire and South Cumbria Integrated Care Board (ICB), presented an overview of the NHS's 10-year health plan, Fit for Future, and its implications for Lancashire and South Cumbria. The plan aims to deliver better care through three key shifts: from hospital to community, from analogue to digital, and from sickness to prevention.

Cass highlighted that the ICB's role is to strategically commission local health services to achieve the best possible outcomes for residents. She outlined significant challenges facing the Lancashire and South Cumbria healthcare system, including increasing demand, longer waiting times, and financial pressures. Opportunities lie in working more strategically with partners, developing neighbourhood health models, and adopting a unified approach to prevention and population health.

Councillor Hargreaves specifically asked about the inclusion of social care within the 10-year plan. Jane Cass confirmed that social care is integral to the plan, particularly in ensuring smooth patient pathways from health to social care.

Councillor Jules raised concerns about the upfront investment required for the plan's priorities and where this funding would come from, given the current financial constraints. Jane Cass acknowledged the difficulty in securing additional funding and stated that the ICB would focus on releasing funding tied up in existing contracts and exploring innovative models. She also confirmed that the ICB would bring back its five-year strategic commissioning plan and neighbourhood health plans to the committee.

Councillor Crimmins expressed scepticism about the plan's ability to make a difference, given that similar themes had been present for decades without significant change, and highlighted the lack of additional funding. Helen Coombs acknowledged the challenges but stressed the importance of practical actions, such as ensuring the workforce has the necessary tools and that data can be shared effectively. She also mentioned pilot projects in Morecambe Bay and East Lancashire focusing on neighbourhood health.

Councillor McCollum questioned the emphasis on the NHS App for managing medications and prescriptions, noting personal difficulties with its current functionality. Jane Cass stated that while the NHS App is a national ambition, local teams are working on improving prescription management and that digital access would not be the sole means of accessing services.

Councillor Jewell reiterated concerns about the digital-first approach, particularly for mental health cases, where face-to-face advocacy is crucial. Jane Cass assured the committee that digital access would not be the only route to services and that the plan aims to prevent inequalities of access.

The committee discussed the need for local plans, with Councillor McCollum requesting a more localised plan for deprived areas like Pendle. Jane Cass confirmed that neighbourhood health plans would be developed at a local level.

Several recommendations were made, including bringing back data from the two neighbourhood health pilots, hearing from community nurses and voluntary sector partners, and ensuring mental health is integrated into future plans.

Secondary Care Orthodontics - Proposed Transformation

Amy Lepiras, an Associate Director of Primary Care, presented a proposal for the transformation of secondary care orthodontic services across Lancashire and South Cumbria. The current service is described as fragile due to workforce shortages, leading to long waiting times and financial unsustainability. The proposed model involves standardising services, creating an advice and guidance service for primary care, and establishing a lead provider model where East Lancashire Hospitals NHS Trust (ELHT) would provide services on behalf of all trusts.

The plan includes a reduction in service sites, with two main hub locations at East Lancashire Hospitals Trust (operating from Burnley General Hospital and Royal Blackburn Hospital) and Chorley and South Ribble Hospital, and two satellite locations at Blackpool Victoria Hospital and Furness General Hospital.

Councillor Crimmins raised concerns about the increased travel distances for patients in North Lancashire, particularly from areas like Lancaster and Kendal, and questioned the viability of Barrow as a satellite clinic given its current unreliability. Amy Lepiras acknowledged the impact on North Lancashire and outlined mitigation strategies, including supporting high street orthodontics, an early discharge scheme, and exploring support for travel costs. The viability of relocating services to Kendal was also being considered.

Councillor Iqbal asked for more details on travel cost support and strategies to attract and retain orthodontic staff. Amy Lepiras stated that travel cost reimbursement options were being explored and that the lead provider model with ELHT was intended to make the service more appealing to the workforce.

Councillor Jewell sought clarification on the relationship with private orthodontists and the impact of the proposed changes. Amy Lepiras explained that the proposed service is NHS-funded and that while private orthodontists handle NHS contracts, the secondary care service focuses on complex cases requiring a multidisciplinary approach.

Councillor McInnis inquired about the impact on staff, including potential changes in employer and consultation with trade unions. Amy Lepiras confirmed that a change of employer was a possibility and that standard HR processes, including trade union consultation, would be followed if the model proceeded.

The committee debated whether the proposed changes constituted a substantial service change requiring public consultation. Councillor Iqbal moved that it was a substantial change, seconded by Councillor Crimmins. The committee voted in favour, deeming the transformation a substantial variation.

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

The committee reviewed its work programme for the upcoming year. A key change noted was the rescheduling of a meeting from 19 January to 3 February 2026 to accommodate a report on the provider services redesign for adult social care.

Councillor Mills raised concerns about the upcoming Cabinet decision regarding care homes and requested condition surveys from 2015 and any subsequent surveys, as well as details of capital spend on those homes since 2015. He stressed the importance of having this information for scrutiny. Helen Coombs confirmed that the condition surveys would be provided and that the team was working on the evaluation framework for the provider services redesign.

Councillor de Freitas asked about the inclusion of the Shaping Care Together process in West Lancashire on the work programme. It was clarified that this would now be handled by a joint committee with Sefton Council.

Councillor McInnes expressed disappointment at the inconsistent approach to allowing visiting county councillors to ask questions, referencing the previous meeting where Councillor Ali was not permitted to speak. The Chair explained that this was a constitutional matter decided by committee vote.

Councillor Jewell raised concerns about the progress of a task group established to oversee recommendations from Care Quality Commission (CQC) inspections. It was noted that this would be followed up.

The committee also discussed key lines of inquiry for the upcoming Health Scrutiny Steering Group meeting on 6 January 2026, which would focus on a service update for Public Health and the NHS Health Checks Programme.

The committee resolved to confirm the work programmes for 2025/26, noting that the Provider Services Redesign item would be included before February. They also agreed to determine key lines of inquiry for the next Steering Group meeting and noted the date and programme change for the next committee meeting.

Other Matters

The committee also noted the minutes of the previous meeting held on 5 November 2025. There were no submitted items of urgent business. The date of the next meeting was confirmed as Tuesday, 3 February 2026.