The Health and Adult Services Scrutiny Committee met on Tuesday 3 February 2026 to discuss improvements to adult social care services following a Care Quality Commission (CQC) assessment, proposed bed reductions at the Royal Lancaster Infirmary, and the committee's work programme. The committee heard updates on the CQC improvement plan, with a focus on transformation priorities for 2026-27. Following extensive debate regarding proposed bed reductions at the Royal Lancaster Infirmary, the committee discussed whether these constituted a significant service change requiring public consultation.

CQC Improvement and Adult, Health and Wellbeing Services Transformation

The committee received an update on Lancashire County Council's progress in responding to the CQC's 'Requires Improvement' rating for its adult social care services. Helen Coombes, Executive Director of Adult Health and Wellbeing Services, presented the report, highlighting that while many positive aspects were noted, including the dedication of the workforce and good user experiences with care providers, areas for improvement included assessment processes, contact methods, and the tools available to staff. A key focus for improvement is co-production, ensuring services are designed with the input of service users.

The report detailed ongoing work across four thematic areas: Working with People, Providing Support, Ensuring Safety in the System, and Leadership. Specific initiatives include a re-scoping of the front door service to improve initial contact, the development of a new Direct Payments policy, and strengthening relationships with the care market through a new market strategy. Safeguarding pathways are being redesigned, and a person-centred model for young people transitioning to adulthood is being implemented. The merger of Adult Services and Public Health into a single directorate aims to enhance collaboration.

The committee was also presented with the transformation priorities for 2026-27, which aim to build on existing improvement work and deliver better outcomes for residents, sustain financial stability, improve customer experience, empower the workforce, build market resilience, drive a place-based approach, optimise in-house provision, and strengthen partnership working. These priorities align with the government's adult social care priorities for local authorities.

During the discussion, councillors raised questions about the digital inclusion of residents who are not digitally savvy, the role of the voluntary sector as an equal partner, and the robustness of internal monitoring systems. Officers assured the committee that efforts were being made to support those not using digital tools through community outreach and face-to-face contact, and that the voluntary sector's role was being strengthened. The importance of robust internal monitoring was acknowledged, with assurances that continuous improvement and strong governance were in place.

Representatives from Age UK Lancashire, including Allison Reed (Business Development Director) and Donna Studholm (Director of Operations), presented their work in supporting older people in Lancashire. They highlighted their Living Well Support Service, which focuses on hospital avoidance and supported discharge, aiming to help individuals remain independent at home. The service reported significant success in reducing hospital admissions and improving well-being, with 75% of clients seeing an improvement in their well-being scores. They also noted that 40% of their clients had internet access, raising concerns about digital exclusion for the remaining 60%.

Francesca Dean, a service user, shared her positive experience with the direct payment scheme, explaining how it had transformed her life and enabled her to live more independently. She advocated for greater support for younger generations of clients and those with disabilities, particularly in areas like housing and mental health support.

Jody Nolan, representing Home Care Services, spoke about the improvements seen since the CQC report, particularly in safeguarding training and communication with the council. She highlighted the benefits of collaboration between care providers and Lancashire County Council, noting that a dedicated provider phone line was being considered to improve access. The company's involvement in the trusted reviewer pilot was also discussed, which allows care providers to increase or decrease care packages based on their direct knowledge of the client's needs.

Jonathan Tomlinson, Occupational Therapy Manager for Lancashire County Council, and Claire Graves, an OT apprentice, presented on the benefits of occupational therapy and the council's apprenticeship program. Claire shared a case study of a 99-year-old woman, Florence, who significantly improved her mobility and independence following a hip fracture, thanks to a rehabilitative approach. The council's commitment to growing its own occupational therapists through apprenticeships was also highlighted.

The committee also discussed the integration of services, with Helen Coombes explaining the work being done to improve relationships and collaboration between the county council, the Integrated Care Board (ICB), and other NHS partners. This includes a refreshed Health and Wellbeing Board and discussions around joint commissioning.

Proposed Bed Reductions at the Royal Lancaster Infirmary

The committee considered proposals from the University Hospitals Morecambe Bay Trust (UHMBT) for bed reductions at the Royal Lancaster Infirmary (RLI). Dr. Helen Skinner, Chief Medical Officer, and Louise Jones, Director of Communications and Engagement, presented the case for reducing the bed base by 24 beds, citing financial pressures and the need to right-size hospitals in line with the NHS 10-Year Plan. They explained that these reductions were supported by increased capacity in virtual wards and improvements in patient flow and discharge processes.

The Trust highlighted that approximately 30% of patients admitted to the RLI did not meet the criteria to reside in an acute hospital setting, leading to prolonged stays and deconditioning. The proposed changes aim to increase the number of patients managed at home through virtual wards, reduce delays in discharge, and ensure patients receive care in the most appropriate setting. The committee was informed that similar bed reductions were already underway at Furness General Hospital.

During the discussion, councillors raised concerns about the impact of these reductions on patient safety, particularly given the current OPEL 4 status (Operational Pressures Escalation Level 4), which indicates significant pressure on services. Questions were asked about the capacity of virtual wards to absorb demand and the potential for increased pressure on community services. Following extensive debate, the committee voted that the proposed bed reductions at the Royal Lancaster Infirmary constituted a significant service change and would therefore require public consultation.

Health and Adult Services Scrutiny Committee and Steering Group Work Programmes 2025/26, Recommendations and In Year Requests

The committee reviewed its work programme for 2025/26. Two in-year requests were considered: one regarding NHS Never Events from Councillor Thomas de Freitas, and another concerning Mental Health Services and integration across other services from Councillor Mark Jewell.

It was agreed that the NHS Never Events request would initially be discussed at the Health Scrutiny Steering Group, with a view to potentially bringing a more detailed report to a full committee meeting in the following municipal year. The request regarding mental health services and integration was noted as being suitable for inclusion in the committee's work programme for the meeting on 22 April 2026, as adult mental health was already scheduled for discussion.

Report of the Health Scrutiny Steering Group

The committee received a report on the Health Scrutiny Steering Group meeting held on 6 January 2026. The group had discussed the Public Health Service Update, including the alignment of Public Health with the Adults, Health and Wellbeing Directorate, the development of a Prevention Plan, and the confirmation of the Public Health grant settlement. They also reviewed the Provision of NHS Health Checks Programme across Lancashire, noting its success in identifying early risks and its innovative use of digital tools, while also acknowledging concerns about digital exclusion.

Joint Health Scrutiny Committee - Shaping Care Together Programme

An update was provided on the Joint Health Scrutiny Committee with Sefton Council, which is reviewing the Shaping Care Together programme. The committee noted that the programme had been confirmed as a substantial variation of service provision, requiring formal public consultation. The first meeting of the joint committee had been held on 20 January 2026, and a further meeting was planned to discuss the consultation outcome and final proposals. Councillor Shaun Crimmins raised concerns about the accessibility of meeting documents, which were hosted on Sefton's website, and the suitability of venues for public attendance and recording. The committee agreed to take these points back to the joint committee.