The Adults and Health Select Committee met to discuss significant changes to adult social care services and the restructuring of the Integrated Care Board (ICB). Key decisions included noting the progress of a new adult social care model and requesting updates on its effectiveness, and agreeing to recommendations regarding the ICB transition, including a focus on health inequalities and risk management.

Transformation of Adult Social Care Services

The committee received a comprehensive update on a significant transformation in adult social care services, which went live in March. This new model aims to address challenges such as multiple entry points into the service (37 in total), leading to delays, missed opportunities for early intervention, and difficulties in supporting carers. The new single front door approach consolidates all new contacts, except those from hospitals, into a more streamlined system.

The model introduces a three conversations approach. The first conversation is handled by the information and advice service, accessible via phone or digital self-serve. The second conversation, Connect to Community, is a new strength-based team that handles all safeguarding referrals (previously managed by the Multi-Agency Safeguarding Hub - MASH), occupational therapy, and aims for early intervention to support independent living through reablement, technology, and carer support. The third conversation involves the area teams, focusing on building a good life and handling more complex cases and timely reassessments. The service has been reorganised into four area-based teams, aligning with the Local Government Reorganisation (LGR) structure.

Data presented indicated that a high proportion of referrals, particularly from professionals, resulted in only information and advice being provided, with a low percentage progressing to open cases. For example, 63% of new contacts from care professionals in 2025 resulted in information and advice only, and 89% of referrals from GPs led to the same outcome. This highlighted a need for better education of referrers regarding the council's services.

Concerns were raised about the communication of these changes to residents, particularly those not online. It was clarified that existing residents known to the service would have their team names and telephone numbers changed, with redirects in place for old numbers. New residents would experience the process as before, with contact details for area teams provided if a service is initiated.

The committee was assured that the new model was not about reducing frontline services but about strengthening and boosting current provision by being more effective with existing staff. There were no headcount reductions planned as part of this restructure. The implementation has involved extensive engagement with professionals and over 30,000 letters sent to residents. Early reflections from the team indicated improved timeliness of contact triage, enhanced multidisciplinary working, and better team cohesion.

The committee noted the outcomes being sought and the changes introduced, recognising the aim to maximise workforce impact through streamlined processes and multidisciplinary teams. They requested a formal update on the effectiveness and impact of the Connect2Community and Area Team model in six months, including performance data on demand management, waiting times, and timeliness of safeguarding processes, with feedback from partners, residents, and staff. They also requested that communications and processes be clear and accessible to avoid digital exclusion, and that social media posts include telephone numbers. A recommendation was also made for a programme of training and education for referrers to improve the appropriateness of referrals.

Integrated Care Board (ICB) Restructure

The committee also received an update on the restructuring of the Integrated Care Board (ICB) covering Surrey and Sussex. From April 1st, NHS Surrey Heartlands and NHS Sussex will merge to become one organisation: NHS Surrey and Sussex Integrated Care Board. This merger is partly driven by the need to reduce operating costs, with the allocated budget for 2026-27 being £59.3 million, a significant reduction from the previous combined budget of £134.5 million. This will result in a reduction of approximately 450 whole-time equivalent posts.

The new ICB will be a strategic commissioner, responsible for commissioning services worth approximately £8 billion for a population of 3.1 million residents. Its functions will include developing long-term health strategies, improving population health, and ensuring coterminous provision of care. The restructuring also involves a three-way split of the former NHS Frimley area, with parts transferring to NHS Surrey and Sussex, NHS Hampshire and Isle of Wight, and NHS Thames Valley. NHS Thames Valley will be the lead commissioner for Frimley Park Hospital.

Concerns were raised about the potential for the ICB's attention and resources to focus disproportionately on Sussex, which has faced more significant challenges with services requiring improvement, potentially leading to a decline in Surrey's service provision. Assurances were sought that services delivered to Surrey residents would remain stable and at the current or improved level of performance. The committee also sought assurances regarding the continuity of provider contracts, patient pathways, and quality oversight functions during the transition.

The ICB representatives stated they would take the best practices from both Surrey and Sussex and work collaboratively with providers to ensure high-quality services. They acknowledged the challenges faced by providers and committed to supporting them. The committee requested an update on the Frimley transfer arrangements, impacts on local population health planning, and clarity on how Surrey's priorities for tackling health inequalities will be embedded in the ICB's plans. They also requested visibility of the ICB's risk management approach during the transition and stressed the need for effective working partnerships with all relevant organisations.

Discussions also touched upon the challenges of driving down health inequalities and narrowing the gap in life expectancy between different areas within Surrey and Sussex, with life expectancy differences of up to 14 years noted. The ICB acknowledged the need for a baseline understanding of population health and the use of data to inform commissioning decisions, with a focus on shifting funding towards prevention and community-based care.

The committee noted the progress and current status of the ICB transition program and requested a focused update on the Frimley transfer arrangements. They also requested an update on the impacts on local population health planning and recommended that Surrey's priorities around tackling health inequalities be made clear within the ICB's operational and strategic plans. Finally, the committee requested visibility of the ICB's risk management approach during the transition and stressed the importance of effective working partnerships.