The Health and Adult Social Services Scrutiny Panel of Ealing Council scheduled a meeting for Thursday, 9 October 2025, to discuss several key areas, including changes to the health landscape, adult social care performance, and direct payments uptake. The panel was also expected to review and agree on its work programme. The meeting was scheduled to be held at Perceval House, 14-16 Uxbridge Road, Ealing, W5 2HL.

Direct Payments Uptake

The panel was scheduled to receive an update on the Adults Services led Direct Payments Project, which was established in late 2024. The project aims to increase the number of adults and carers who opt to receive their social care support via a direct payment, rather than through council commissioned care services.

The report pack included the council's four-year plan, which included a priority to:

empower people and families who receive support for social care to have greater freedom, control, and power over how that money is spent, bringing people, families, and communities together through a mutual and cooperative approach to commissioning care.

The project set several key actions, including increasing the number of adult direct payment users to 600 and carer direct payment users to 150 by March 2026, reviewing existing direct payment processes, establishing a co-production group to refresh communication materials, actively engaging with social workers to promote uptake, reviewing Ealing Direct (the in-house direct payments support team), and creating a direct payments social care market directory.

As of September 2025, adult direct payment uptake stood at 342, with analysis suggesting it would peak at 400-500 by March 2026. Carer direct payment uptake was at 109, with analysis indicating it could reach 300 plus by March 2026. Internal Audit conducted a review of direct payments processes in December 2024, concluding that the processes and forms in use were appropriate and proportionate.

A co-production group was established, co-chaired by a member of the Direct Payments User Group (DPUG), which refreshed the direct payments guide, developed a new easy-read version, and produced an explainer animation video. A Direct Payments Marketplace event was held on 10 July 2025. A mandatory training programme was devised and ran from November 2024 to June 2025, with around 150 social workers and social care assistants completing the training. A review of Ealing Direct was undertaken, and additional resources were identified, including funding for two additional support planners. Ealing Direct has also made use of a new AI tool, Magic Notes, to improve the time taken to produce support plans.

Adults services has been working with corporate colleagues to devise a care services mapping exercise across Ealing's seven towns¹.

Adult Social Care Performance

The panel was scheduled to discuss the performance of adult social care services. The report pack included that there had been significant improvements in the operational and financial performance in Adult Social Care over the past 12 months. This work has been underpinned by a departmental wide business plan with specific focuses on operational effectiveness, structure, financial transformation, governance and quality.

In February 2025, the department launched its new resident journey, articulating how residents should experience social care. The Resident Journey articulated the journey into three distinct parts: first contact, intermediate care, and long-term care.

The resident journey has been supported by a large and growing set of procedures and protocols, as well as new service standards. This, combined with focuses surge activity, has seen an overall improvement across a number of key areas of performance, including eliminating backlogs at initial referrals, completing initial screening assessments, and reducing the median wait for assessment in care act² assessments.

As of 4 September 2025, police referrals waiting for review stood at 8, with the oldest 24 hours old. Adult Social Care officers seek feedback from residents at the end of each review or assessment episode, with feedback consistently showing a satisfaction rate each month of over 97%. In July 2025, 78% of care homes and 81% of home care providers were rated good or outstanding by the Care Quality Commission (CQC).

The report pack stated that there are further areas for improvement, including the waiting list for occupational therapy (OT) assessments, annual reviews, and carers pathway, as well as modernising the digital contact journey for residents.

The practice improvement work in adult social care has been carried out against the backdrop of a continued challenging financial position in the council. A review of staffing expenditure was carried out in October 2024, resulting in an in-year reduction of £0.5m on agency spend, resulting in £1m less being spent on agency staff in 2025/26.

Adult social care has a net revenue budget of £113.910m per annum, with the majority (70%), £79.891m net expenditure on support plans. The medium-term financial strategy focuses on delivering excellent strengths-based support plans, maximising funding streams including client contributions. To date, the Transformation and Financial resilience programme has delivered savings totalling more than £4.3m full year effect savings delivering in year cost reductions of £2m for 25/26.

Changes to the Health Landscape

The panel was scheduled to discuss the changing role of NHS Integrated Care Boards, the new course for the NHS set out by the Ten Year Health Plan, Neighbourhood Health, and the role of the Integrator.

In February, the government announced the plan to abolish NHS England (2027) and reduce funding and staffing in ICBs by 50% from April 2026. The Model ICB Blueprint document describes how functions of the ICB will change in the context of the expected changes to the wider provider landscape. The focus of ICB work will change to focus on strategic commissioning with some functions of the ICB transferring to providers.

The ICB will focus on understanding local needs, planning long term, using funding well, and checking impact. For contracts, this means the ICB will negotiate and manage outcome-based contracts, keep track of how services perform, and make sure there is good governance and everything offers good value for money.

North Central London and North West London are both high-performing systems and both in financial balance. The two organisations are aligned in vision, approach to strategic commissioning, and have a natural affinity due to proximity and working relationships. Both have large and complex provider landscapes, a high proportion of specialist services, and world-leading universities. Both have stark health inequalities and populations that are more diverse and transient than the England average.

Both NC London and NW London Boards made independent decisions at their July meetings to proceed with a full merger. By bringing together the best of both organisations, merger gives the best chance for excellence in strategic commissioning, that delivers for the residents of north central and north west London. It will create a resilient and ambitious ICB that can continue to focus on improving access to health, reducing inequalities, moving services closer to the community through neighbourhood delivery, and ensuring the health system works better than it does today.

An implementation plan will be developed during the summer and will be tabled at a future Board meeting. The implementation plan will include building new teams with the skills and talent required for success, managing organisational change with care and transparency, creating a culture where staff feel supported and valued, undertaking quality and equality impact assessments, developing Place in the new operating model, and actively engaging partners and stakeholders across the system.

In early September, NHS England appointed a single Chair for both organisations, Mike Bell, who will also oversee the merged ICB from April 2026. Frances O'Callaghan remains the CEO of North Central London. Rob Hurd will leave North West London as CEO on 12 September. A new joint CEO will be appointed.

The Ten Year Health Plan sets out a bold, ambitious, and necessary new course for the NHS. It seizes the opportunities provided by new technology, medicines, and innovation to deliver better care for all patients and better value for taxpayers. The plan includes three shifts: from hospital to community, from analogue to digital, and from treatment to prevention.

Neighbourhood Teams will provide seamless community-based care and are accountable for their local population and the individual needs within it. They will all be geographically aligned to a population of c.50,000 100,000 residents and will all contain the core services of General Practice, VCSE³, Public Health intelligence, Adult Social Care, Domiciliary Care, Children's Services, Health Visiting, Social Prescribing, Care Navigation, Community Mental Health, Community Nursing, Community Therapies, Community Pharmacy, Dentistry, and Optometry.

Ealing is transitioning to 8 Neighbourhood Teams covering the London Borough of Ealing, based on the current Primary Care Networks footprint. Each locality Integrated Neighbourhood Team is led by a Leadership Team with membership from Primary Care Networks (PCNs), Adult Social Care, Mental Health Integrated Network Teams (MINT), Recovery Interventions Service Ealing (RISE), Ealing Community Partners, Voluntary Sector, and representation from relevant NHS trusts.

The Place-Based Integrator is required to be an NHS body, Local Authority, or other statutory partner and would undertake the following functions:

• Convening partners to develop a shared understanding of the needs of the population.
• Developing a shared plan to address these needs.
• Overseeing the implementation of the plan.
• Monitoring progress against the plan.
• Ensuring that resources are used effectively and efficiently.

Panel Work Programme

The panel was scheduled to review and agree on its work programme. The work programme manages the panel's priorities and includes issues the panel needs to consider as part of its oversight role in monitoring NHS and council performance and policy implementation. The panel reviews the work programme at each meeting to ensure flexibility to cover new issues as they arise.