The Adult Social Care and Health Overview and Scrutiny Committee met to discuss winter planning for urgent care, recommissioning of public health nursing services for young people, and the integrated performance report for quarter one. The committee requested more information on the use of artificial intelligence (AI) in adult social care assessments, and agreed to add a discussion of direct payments to the work programme. The committee also approved the recommendations of the Quarter 1 Integrated Performance Report 2025/26.

Council Tax and Adult Social Care Funding

Councillor Max Langer asked Councillor Anne-Marie Sonko, Portfolio Holder for Adult Social Care and Health, about plans to control overspending in adult social care to avoid raising council tax by the full 5%. Councillor Sonko responded that the finance portfolio holder is exploring the use of AI to gain efficiencies without cutting services, including in adult social care and health.

Councillor Langer requested more detail on how AI would be used, particularly in the context of adult social care. Councillor Sonko said AI might be introduced into the assessment process to refine the understanding of a person's needs. She offered to provide a more detailed answer from the finance portfolio holder, and to circulate it to all committee members.

Councillor Pamela Redford raised concerns about over-reliance on AI at an early stage of its development. Councillor Tracey Drew, an ex-social worker, also expressed concern about the use of AI in assessments and requested a briefing on how AI would be used.

Councillor Sonko responded:

I want to make sure that it's totally scrutinised before, like I said, and speak to other councils that have used it before even taking a step, because you can't replace people with AI. And I'm very, very aware of that.

She agreed to prepare a briefing if further investigation suggests it is worthwhile.

Winter Planning for Urgent Care

Rachel Danter, Chief Transformation Officer at the Integrated Care Board (ICB), presented the winter plan for urgent care in Coventry and Warwickshire. The plan aligns with national requirements in the urgent and emergency care recovery plan and addresses risks anticipated during the winter. The plan includes sections on demand and capacity, infection prevention and control, prevention (including vaccinations), and schemes supported by the Warwickshire Care Collaborative and the Coventry Care Collaborative. The total budget allocated for winter was just over £10.5 million.

The plan covers nine key areas:

• working with partners, including local authorities
• primary care
• secondary care
• mental health services
• operational resilience
• mutual aid
• communications and engagement

The plan is based on preventing illness, resourcing capacity, and leadership support. The ICB is also looking at integrated urgent care in the medium term, commissioning services across the whole pathway for urgent care rather than in silos.

Councillor Kate Rolfe asked about the 15 winter schemes approved for South Warwickshire, including a new scheme for pathway one CRS discharge¹. Danter explained that this scheme aims to support patients to leave hospital quicker by providing domiciliary care in their own homes. Councillor Rolfe requested details of the other 14 schemes, which Danter agreed to provide.

Councillor Redford asked about surge and super surge scenarios and how the ICB would cope with bed shortages. Danter clarified that surge refers to the stepping up of extra beds, using temporary workforce agency or bank staff to support those beds. Super surge involves putting beds into ward areas. Councillor Redford sought assurance that this meant beds in wards, not corridors. Danter confirmed that the definition referred to beds in wards.

Councillor Langer expressed interest in the integrated urgent and emergency care pathways, and asked about the governance around the transformation work and which bodies outside of the ICB are involved. Danter explained that the ICB is working through a four-phased approach:

1. Defining the scope of services
2. Looking at the model of delivery, using the care collaboratives and engaging with partner organisations, including the local authority and voluntary sector
3. Going through a formal procurement process
4. Mobilising contracts and ensuring they deliver the expected outcomes

Chris Bain, Chief Executive of Healthwatch Warwickshire, commented that NHS plans tend to be activity-focused, while Healthwatch focuses on the impact, outcomes, and experiences of patients. He asked how this is taken into account. Danter responded that the ICB's role is changing to focus on understanding the needs and outcomes that the population would like from services, and then measuring whether those services deliver what they promise. Rose Uwins added that the population is one of the stakeholders and it is important that their priorities have an impact.

Recommissioning of 0-19 Public Health Nursing Service

Dr Shade Agboola, Director of Public Health, provided an update on the recommissioning of the 0-19 and up to 25s (for SEND²) public health nursing service. Since 2013, the council has had a statutory duty to commission school nursing and health visiting services. Since 2015, the 0-5 health visiting service has been delivered by SWFT and the 5-19 school nursing service has been delivered by Compass. The existing 0-5 contract was coming to an end in March 2024, so the recommissioning process began in March 2023.

After considering various options, a 0-19 service scored highest across all criteria. Cabinet approved the procurement of a 0-19 public health nursing service in October 2024. HCRG Care Services was the successful bidder.

The service specification prioritises:

• prevention
• early intervention
• reducing health inequalities
• improving access to services
• providing the right support at the right time
• fostering integration and greater collaboration with partners

The service will deliver the five mandated health visitor contacts, an infant feeding offer, a more intensive health visiting offer for vulnerable families, the national child measurement program, safeguarding elements, a whole family lifestyle program, and health assessments linked to looked after children.

The service will provide an intensive offer to families classed as vulnerable, including those affected by:

• domestic abuse or violence
• low maternal age (under 19)
• mental health concerns
• substance misuse
• learning or physical disabilities
• living in the most deprived areas
• parents of children with special education needs
• single parents
• those living in care
• transient communities
• parents living in temporary accommodation
• asylum seekers
• refugees

There are six overarching outcome areas:

• happy infants, children and young people
• reducing risky behaviour
• improving lifestyles
• maximizing learning and achievement
• supporting complex well-being needs
• ensuring a seamless transition and preparation for adulthood

The contract award was delayed due to the local elections in May and receipt of written representations from the successful provider. The existing contracts have been extended until 30 November 2025, with a go-live date of 1 December 2025. Weekly demobilisation meetings are taking place with the current providers, and weekly mobilisation meetings with the new provider.

A key change is a move away from a siloed approach to supporting mothers under 19, to a less siloed offer that allows a wider cohort of staff to support families with a range of vulnerabilities.

In response to a question about the more intensive health visiting offer for vulnerable families, Dr Agboola clarified that this includes mothers of low maternal age.

In response to a question about staffing levels, Dr Agboola acknowledged that there has been a decline nationally in the health visiting workforce, but the new service provider has given assurances that this will not be an issue.

In response to a question about whether it would be cheaper to bring the service back in-house, Dr Agboola said that this was explored but was not a feasible option.

Councillor Redford asked whether the council had spoken to other authorities where HCRG Care Group manages contracts. Dr Agboola confirmed that they had spoken to commissioners in Essex, who were happy with the service provided, and also to Herefordshire and Lancashire.

Councillor Langer emphasised the importance of a smooth transition and making people aware of the change in service.

Quarter 1 Integrated Performance Report

The committee considered the Quarter 1 Integrated Performance Report 2025/26. The report included two recommendations, which the committee approved:

1. To consider and comment on quarter one organisational performance, progress against the council delivery plan, management of finances and risk.
2. To request that officers support portfolio holders and overview and scrutiny committees to refresh the council's performance management framework ahead of 2026-27, including building in the new local government outcomes framework, and bring a new performance management framework to cabinet for approval no later than March 2026.

The report is a retrospective summary of organisational performance at the end of quarter one (April to June 2025). 74% of key business measures (KBMs) are classed as delivering. Of the 12 KBMs attributable to the Adult Social Care and Health OSC, 11 are being reported at quarter one, and 8 of these (72%) are delivering. Areas of strong performance include the percentage of smokers successfully quitting at four weeks, and the average time people are waiting for a domiciliary care package. Areas that remain a challenge include the percentage of adult social care service users receiving a direct payment at the end of the month, which is below the preferred target of 25%.

At the end of quarter one, services reporting to Adult Social Care OSC are forecasting a cumulative net service overspend of £0.87 million after transfers from earmarked reserves are accounted for, equivalent to 0.3% of their revenue budget. Savings targets are forecast to be achieved for 2025-26. The strategic and directorate risk profiles have remained stable for this quarter.

Councillor Rolfe asked who chooses the 25% target for adult social care service users receiving a direct payment, and why it isn't higher. Pete Sidgwick, Director of Social Care and Support, explained that the national average is around 25%. He clarified that a direct payment is where someone has an assessed need under the Care Act³, and rather than the council commissioning something for them, they take a cash alternative and employ people themselves. He said that some people will not want to employ people, and that the majority of those who have a direct payment are under 65. He added that the council needs to make sure that it has a good offer and a supportive offer to people who do want to take that cash alternative.

Councillor Rolfe asked about a drop in the August take-up of direct payments, followed by an increase in September. Sidgwick explained that there are ongoing direct payments and one-off direct payments, and that the fluctuation is likely to be around the one-off direct payments, for example to support carers.

Councillor Drew supported Councillor Rolfe's request to move forward the scheduled briefing or discussion on direct payments as soon as possible, and to include lessons learned from the national picture.

Sidgwick clarified that the overspend in social care and support is 0.47%, not 2.6% as stated in the report. The difference is due to a programme introducing new software across children's and adults and education, which draws down on corporate reserves.

Work Programme

The committee discussed the work programme and agreed to add a discussion of direct payments to the next meeting. Councillor Rolfe noted that a joint Teams briefing on Child and Adolescent Mental Health Services (CAMHS) had been held on 3 September in lieu of a joint meeting.