To receive any declarations of interest from Committee members in relation to items on this agenda.

There were two declarations of interest made:

To confirm the minutes of the previous meeting held on 27 January 2026.

The minutes of the meeting held on 27 January 2026 were agreed as a correct record.

To receive any reports on business which, in the opinion of the chair, should be brought forward for urgent consideration.

There were no items of Chair’s Urgent Business.

Sharon Richards (Lead Accountant) presented the Adult Social Care Finance Report – Month 10, 25/26 and discussed:

a)     The purpose of the report was to provide an overview of Adult Social Care’s forecast budget position at Month 10 (2025/26), including key pressures, additional income, and actions being implemented to strengthen budgetary control, alongside progress against the approved savings programme;

b)    Adult Social Care was reporting an overspend of £3.309m at Month 10 (Budget £113.455m, Forecast £116.764m);

c)     Domiciliary Care continued to experience increased demand, including demand for intermediate care to support clients’ discharge from hospital;

d)    As assessment waitlists had reduced, the directorate had seen a significant increase in bedded care clients (previously flagged as a risk), and backdated packages had resulted in £0.783m of prior-year costs being incurred in-year;

e)     £4.455m of additional joint funding and client income had been identified, correlating with increased package expenditure, and a joint funding panel had been established to improve governance and procedures and to ensure the maximum level of funding was recovered;

f)      Following the insolvency of the previous Community Equipment Service provider, an inflationary increase had been agreed to ensure the continuation of service delivery;

g)     The directorate’s Budget Containment Group had been mobilised for 2025/26, with activity ongoing to focus on emerging high-risk areas and to assign task groups to identify actions to contain spend (including focused package reviews);

h)    Workstreams identified through the Budget Containment Group included review and analysis of domiciliary care, bedded care fee levels, and pipeline demand timescales, alongside planning for increased clients in direct payments, and a focus on short-term residential clients to identify barriers to longer-term care;

i)      Total savings targets of £3.421m had been set for 2025/26 (including £2.733m of 2025/26 step-up delivery plans and £0.648m carried forward from prior years), with total savings of £2.919m achieved and the remaining balance of £0.506m declared unachievable.

In response to questions, the Committee discussed:

j)      Concerns that part of the savings programme had been declared unachievable, and the impact of this on the wider budget.

The Committee agreed:

1.     To note the Adult Social Care Finance Report – Month 10 25/26.

Julia Brown (Service Director for Adult Social Care), Gill Nicholson (Head of Innovation and Delivery), and Ian Lightley (Chief Operating Officer, Livewell Southwest) introduced the Adult Social Care Performance Monitoring Report and discussed:

a)     Officers had last attended the Panel at the end of January 2026 and, as this update was outside the usual quarterly reporting cycle, the level of change since the previous report was limited;

b)    The report provided an overview of Adult Social Care activity and performance and described how services supported people in Plymouth to live in their own communities;

c)     Performance reflected both progress and ongoing pressures across assessments, reviews, reablement and care delivery;

d)    The focus remained on timely, high quality, person centred support, improved flow through the system and close partnership working with Livewell Southwest and wider system partners;

e)     The report was intended to provide transparent oversight and assurance that services continued to improve and work towards sustainable, high-quality care for residents.

Ian Lightley (Chief Operating Officer, Livewell Southwest) presented the performance data and discussed:

f)      Demand and activity had increased between December and January, as expected, but triage at the front door continued to be completed within five days, and the average time to complete assessments once allocated to a social worker remained strong at approximately 29 days;

g)     Pressure remained between triage and allocation to a social worker, resulting in a slight increase in waiting times, with capacity and caseload pressures identified as the cause rather than processing issues;

h)    Completed reviews increased significantly in January, with 373 completed compared to 263 in December, and reviews continued to be prioritised based on risk, urgency and need;

i)      Performance against national benchmarks was affected by under recording of proportionate reviews where circumstances had not materially changed, and work was underway to improve recording and data accuracy;

j)      Data on reviews resulting in reduced or unchanged care was not yet available due to data quality issues, with further work required before this could be reported in future updates;

k)     Waiting lists for occupational therapy continued to reduce, and the phase one target had been achieved, although the overall number of people waiting remained high;

l)      Work was progressing to separate Adult Social Care Occupational Therapy activity from Health Occupational Therapy activity within the integrated service, with a working document and outline plan now in place;

m)   The number of people in residential and nursing care placements remained higher than forecast at the start of the year, although placement activity had stabilised since November;

n)    Market position statements were being revised to provide improved intelligence on demand and capacity, particularly in relation to complexity of need rather than overall bed numbers;

o)    Work continued to sustain the Care Home Framework introduced in January and the Extra Care contract, supporting greater market stability and financial control;

p)    Domiciliary care packages continued to grow, partly driven by hospital discharge pressures, and a reablement first approach was expected to help stabilise demand and reduce package hours  ...  view the full minutes text for item 127.

The Committee agreed a change to the order of business to bring forward item 12, Social Workers Deep Dive.

Ian Lightley (Chief Operating Officer, Livewell Southwest) presented the Social Workers Deep Dive report and discussed:

a)     Livewell Southwest had held delegated authority from Plymouth City Council since 2015 to undertake Care Act assessments, reviews and safeguarding enquiries, operating within the statutory framework of the Care Act;

b)    Social workers played a central role in determining eligibility for care and support, promoting independence, signposting to community resources, undertaking Mental Capacity Act assessments and leading safeguarding and best?interest decision?making;

c)     Social work at Livewell Southwest operated within a highly integrated model, with social workers embedded across a range of specialist teams rather than a single generic service, supported by overall organisational leadership and coordination;

d)    The workforce comprised 86 registered social workers and 63 social care practitioners, with the latter being skilled but non?registered practitioners, formerly known as community care workers;

e)     Occupational therapists also undertook Care Act activity but were excluded from this deep dive to maintain focus on the social work workforce;

f)      Workforce age?profile data showed a significant proportion of staff approaching retirement age, but retention levels within Livewell Southwest remained strong compared to comparator organisations;

g)     There was no nationally agreed or consistent benchmark for the “correct” number of cases per social worker, but experience suggested 20–30 cases was a reasonable level for longer?term teams, with lower caseloads in high?throughput services such as hospital discharge and intermediate care;

h)    Caseload expectations varied depending on complexity and throughput, with active management through supervision to ensure workloads remained reasonable and safe for individual practitioners;

i)      Productivity was best understood by considering both caseload size and volume of completed work, with 170 assessments completed across teams in January, although benchmarking across authorities remained difficult due to different systems and service models;

j)      Retention had been supported through organisational approaches adopted post?pandemic, including a “train, retain and reform” model, internal development routes and a strong Assessed and Supported Year in Employment (ASYE) programme;

k)     Recruitment was supported through local careers fairs, links with universities, the ASYE programme, and a dedicated workforce attraction and retention team, alongside structured career development opportunities;

l)      Sickness absence across social care was higher than desired, at approximately 8.6%, compared to an organisational average of just over 6%, partly driven by a small number of long?term absences in specific areas;

m)   High retention helped offset some of the impact of sickness absence by reducing turnover?related productivity loss, although further work was required to reduce sickness levels;

n)    Strength?based practice was being rolled out in response to the Care Quality Commission inspection, with a practice model developed, training approved and engagement with lived?experience groups underway;

o)    Work continued with Carers Trust on implementing the Triangle of Care model within adult social care, with Livewell Southwest piloting the approach and seeking accreditation, supporting a shared culture across health and social care teams;

p)    Further work on transitions pathways was underway, with a more detailed discussion planned  ...  view the full minutes text for item 128.

Peter Collins (Chief Medical Officer, NHS Devon Integrated Care Board) provided an update on Integrated Care Board (ICB) clustering arrangements and discussed:

a)     The update related to the ongoing work by NHS Devon ICB, Cornwall and Isles of Scilly ICB, and Plymouth partners to meet Department of Health and Social Care requirements to reduce running costs to a standard per?head allocation and refocus organisations on strategic commissioning;

b)    The national requirement to reduce running costs had been announced approximately 12 months earlier, with organisations now reaching the stage where outcomes from restructuring activity were beginning to emerge;

c)     Steve Moore had stepped down as Chief Executive of NHS Devon, and as Chief Executive Designate of the Devon, Cornwall and Isles of Scilly ICB cluster;

d)    The recruitment process for a new Chief Executive, either interim or permanent, had closed, with an announcement expected shortly;

e)     Phase one consultation and appointments to a single executive team across Devon, Cornwall and the Isles of Scilly had concluded, with announcements expected imminently;

f)      The next phase would include the appointment of directors, establishing senior leadership across organisations which would remain legally separate for the next 12 to 24 months. Further restructuring activity would continue beyond this phase;

g)     Clustering provided opportunities to integrate workforce effort across a larger population footprint and share learning, including nationally recognised work in Cornwall on integrated neighbourhood teams;

h)    Risks associated with clustering included organisational distraction during a period of significant leadership and structural change.

In response to questions, the Panel discussed:

i)      The potential impact of workforce reductions on patient outcomes, with officers explaining that reduced running costs were intended to increase focus on strategic commissioning, population health management and data?driven decision?making rather than programme delivery functions;

j)      The expectation that commissioning activity would increasingly focus on understanding population need through high?quality data and contracting effectively with providers to meet those needs;

k)     The distinction between ICB running costs and overall health system funding, with officers noting that the running?cost requirement related to administrative expenditure rather than frontline service budgets;

l)      The importance of demonstrating to the public and elected Members that the revised operating model delivered at least equivalent, and ideally improved, outcomes for residents;

m)   Concerns about national decision?making and health system reform, with officers clarifying that responsibility at local level was to implement national requirements as effectively as possible for the benefit of the local population;

n)    Requests for further information be brought to the Panel at a future meeting, once detailed arrangements were known, to support understanding of the new operating model.

Action: NHS Devon ICB to arrange for the incoming cluster leadership to present a future report outlining the target operating model for the Devon, Cornwall and Isles of Scilly ICB cluster and how this was expected to benefit population outcomes.

The Panel agreed:

1. To note the ICB Clustering Update.

The Committee agreed a change to the order of business to bring forward item 9, Electronic Patient Record update.

Amanda Nash (Head of Communications, University Hospitals Plymouth NHS Trust), Sarah Brampton (Deputy Chief Executive, University Hospitals Plymouth NHS Trust), and Sally King (Senior Clinical Information Officer, University Hospitals Plymouth NHS Trust) presented an update on the implementation of the Electronic Patient Record (EPR) and discussed:

a)     Epic was the Electronic Patient Record system being implemented at Derriford Hospital from July, replacing a largely paper?based and fragmented set of clinical systems with a fully digital hospital record;

b)    The system would provide a single, unified patient record accessible across services, enabling clinicians to view scans, test results and clinical notes in one place and improving continuity of care;

c)     Patients would be able to access elements of their hospital record digitally, including via a mobile application, supporting greater transparency and engagement;

d)    Epic had been selected following a robust procurement process, with consideration of multiple systems available on the market;

e)     Epic was already in use within the UK, including at Royal Devon, Torbay, Cambridge University Hospitals, University College London Hospitals, Manchester, Great Ormond Street Hospital and The Royal Marsden;

f)      Adoption of Epic across Plymouth, Royal Devon, Torbay and North Devon would create a shared county?wide system, allowing staff and patients to access records seamlessly across sites;

g)     The shared system would support staff working across organisations and improve joined?up care for patients receiving treatment at more than one hospital;

h)    Epic had been live at Royal Devon since 2020, providing assurance on system maturity, stability and usability;

i)      The organisation placed strong importance on Epic’s values, ethics and commitment to reinvesting in healthcare improvement;

j)      The introduction of Epic would significantly improve care coordination, reducing the need for patients to repeatedly share their medical history with different services;

k)     Digital records and embedded clinical decision support would enhance patient safety, supporting clinicians with prompts and alerts while retaining professional autonomy;

l)      The system would support more collaborative conversations with patients, enabling shared decision?making and improving patient experience;

m)   Digital communication options would improve efficiency for patients who chose to engage electronically, while alternative non?digital routes would remain available;

n)    Epic would provide opportunities for greater consistency and standardisation across departments, while allowing variation where clinically appropriate;

o)    The local patient portal was branded as “My Care”, known nationally within Epic as “MyChart”;

p)    Over 250,000 patients were already registered to use My Care at Royal Devon, with approximately 70,000 patients actively logging in;

q)    Patients could view appointments, test results and selected clinical information via the portal, without providing access to the full clinical record;

r)     Proxy access allowed patients with capacity to share access with carers or family members, with clinically led best?interest decisions applied where patients lacked capacity;

s)     Survey findings from Royal Devon were highlighted, including:

                 i.         A 2024 survey showed 90% user satisfaction, with key benefits including rapid access to test results, appointment information and reminders;

                ii.         Feedback highlighted the importance of greater integration across hospital services and  ...  view the full minutes text for item 130.

Professor Steve Maddern (Director of Public Health), Teresa Cullip (Consultant in Public Health) and Alex Degan (Primary Care Medical Director, NHS Devon ICB) provided an update on vaccination activity across Plymouth, and discussed:

a)     The Plymouth Protects campaign had focused on increasing vaccination uptake, particularly within vulnerable communities, through joint working with system partners;

b)    Activity to date included city?wide poster campaigns and a targeted social media campaign, which had resulted in approximately 5,300 visits to the vaccination information webpage;

c)     Future work would focus on improving uptake of the HPV vaccine in school?aged children and increasing vaccination rates among older adults;

d)    Eligibility for NHS vaccination programmes was determined nationally, but work would continue with the vaccination outreach team to support access for frontline voluntary sector colleagues within national eligibility criteria.

In response to questions, the Panel discussed:

e)     Vaccination coverage for children in care, with officers confirming that overall uptake sat in the mid?70% range, which was slightly below the typical national target of 80%, noting that figures covered all vaccines combined and masked variation between individual vaccines;

f)      Data limitations for children in care, with officers explaining that vaccine?specific breakdowns were not currently available for this cohort, highlighting an ongoing gap in intelligence;

g)     The importance of continued engagement with children in care services to maintain and improve vaccination uptake;

h)    Uptake of the MMR vaccine and the availability of single?component vaccines, with officers advising that the standard NHS offer was the combined MMR vaccine, with limited exceptions for specific clinical circumstances;

i)      Advice for residents concerned about MMR vaccination, with confirmation that individuals should discuss concerns with their GP to explore appropriate options;

j)      Clarification that individual measles, mumps and rubella vaccines were not routinely available through the NHS.

Alex Degan provided a further update on the winter vaccination programme and discussed:

k)     Eligibility for flu and COVID?19 vaccinations was set nationally by the Joint Committee on Vaccination and Immunisation (JCVI);

l)      The flu programme criteria remained broadly consistent, while COVID?19 eligibility had narrowed for the 2025/26 winter programme, including removal of eligibility for those aged 65–75 and for some frontline health and care workers;

m)   Plymouth and Devon continued to perform above the national average for flu and COVID?19 vaccination uptake;

n)    University Hospitals Plymouth had significantly increased flu vaccination uptake among frontline healthcare staff;

o)    Care home vaccination uptake in Plymouth approached 80%, exceeding regional and national averages, which was particularly important given the vulnerability of residents;

p)    Uptake of the RSV vaccination showed early positive indications, with emerging evidence suggesting significant reductions in emergency department attendance and hospital admissions, although national evaluation data was still awaited;

q)    Despite a wider range of vaccination delivery sites, including community pharmacies, uptake had not increased significantly, highlighting the continued need for targeted engagement and promotion, particularly for vulnerable groups;

r)     Future responsibilities associated with ICB clustering would place greater local emphasis on immunisation and vaccination delivery,  ...  view the full minutes text for item 131.

Councillor Aspinall (Cabinet Member for Health and Adult Social Care) introduced the Dental Care report and discussed:

a)     The update focused on progress made in addressing Plymouth’s longstanding challenges around NHS dental access and oral health inequalities;

b)    The Dental Task Force had been established in 2023 and had brought together partners across the system to improve outcomes for residents;

c)     Progress had been made against the Task Force’s three original priorities;

d)    The new Peninsula Dental Social Enterprise (PDSE) City Centre dental facility had opened earlier in the month and was now providing urgent stabilisation care for people who would otherwise struggle to access treatment;

e)     The opening of the City Centre facility represented a significant milestone for Plymouth and helped to ease pressure on urgent and emergency services;

f)      Substantial investment from NHS Devon had been secured to expand prevention programmes;

g)     Supervised toothbrushing and oral health education programmes were now reaching thousands of Plymouth children, particularly in the most disadvantaged areas. These prevention programmes were critical to reducing inequalities and improving long?term oral health outcomes;

h)    Members were encouraged to visit primary schools in their wards to observe supervised toothbrushing schemes in operation;

i)      A dedicated dental pathway for people experiencing homelessness was now operating, with further expansion agreed to meet increasing need. This pathway formed an important part of improving access for high?priority groups;

j)      Despite strong progress, challenges remained, and the Dental Task Force had agreed two new priorities for 2026: improving access for children not currently seeing a dentist, and strengthening the local oral health workforce to ensure sustainability and capacity;

k)     Ongoing focus would continue on vulnerable adults, including older people receiving care and individuals experiencing multiple disadvantage.

In response to questions from the Panel, additional clarifications were provided by Peter Collins (Chief Medical Officer, NHS Devon) and Melissa Redmayne (Dental Commissioner, NHS Devon ICB):

l)      Continued gaps in NHS dental provision across both the north and south of the city, with concerns raised about travel costs, accessibility, and the impact of the cost?of?living crisis on families;

m)   Workforce shortages and the limitations of current national dental contracts, which did not adequately incentivise NHS provision;

n)    The limited uptake of the national “golden hello” incentive scheme for dentists and the need to explore alternative or enhanced retention?based incentives;

o)    Challenges in increasing local dental training capacity, including confirmation that proposals to expand dentist training places in Plymouth would not proceed;

p)    The importance of encouraging newly trained dentists to remain in Plymouth, including through postgraduate opportunities and local training placements;

q)    Recruitment and retention issues linked to end?stage training placements, with evidence showing dentists tended to settle where they completed training;

r)     Barriers faced by internationally trained dentists, particularly delays associated with national registration processes;

s)     The suggestion of reframing recruitment incentives as a “golden stay” model, linking financial support to a period of NHS service;

t)     Clarification that traditional dental “waiting lists” no longer operated in  ...  view the full minutes text for item 132.

Peter Collins (Chief Medical Officer, NHS Devon) introduced the Armed Forces Care report and discussed:

a)     The item focused on primary care support for veterans and the General Practice Armed Forces?friendly accreditation scheme;

b)    The accreditation scheme represented a positive initiative, supporting more tailored and informed care for veterans within primary care;

c)     All local GP practices had signed up to the scheme, demonstrating strong engagement from primary care colleagues;

d)    The scheme aimed to provide more bespoke and focused care to veterans, recognising the debt owed to those who had served in the armed forces;

e)     The work illustrated how local services were seeking to make a tangible difference for the armed forces community.

In response to questions, the Panel discussed:

a)     Whether NHS organisations had signed up to the Armed Forces Covenant using national pledges or organisation?specific pledges;

b)    Clarification that individual NHS organisations chose to sign up to the Covenant and set out how they would deliver commitments in practice, rather than the NHS signing as a single body;

c)     The principle of clinical prioritisation, with officers explaining that veterans did not “jump the queue”, but where two patients had the same clinical need, veterans should be prioritised in organisations that had adopted Covenant commitments;

d)    Concerns raised by Members regarding feedback suggesting veterans and serving personnel were not consistently receiving appropriate priority in practice;

e)     The distinction between veterans and serving personnel within current policy, and the perception that guidance was applied more consistently for veterans than for those currently serving.

Allison Treadgold (Head of Armed Forces Health, NHS England) provided clarification on national policy and statutory duties, and discussed:

f)      The Armed Forces Covenant comprised two elements: the original voluntary Covenant and the statutory duty introduced under the Armed Forces Act 2021, which came into force in 2022;

g)     The statutory duty applied to specific public bodies and functions, including health, housing and education, and required organisations to give “due regard” to the needs of the armed forces community;

h)    The statutory guidance required NHS organisations to ensure veterans with conditions attributable to their service received priority treatment, subject to clinical need;

i)      Priority treatment applied where two patients had the same clinical condition and level of need, with the veteran being prioritised;

j)      This principle had existed for many years within NHS access policies, historically referenced as “war pensioner” prioritisation;

k)     No equivalent national policy currently existed requiring prioritisation of serving personnel, with current expectations focused on ensuring no disadvantage rather than creating advantage;

l)      Local arrangements and Armed Forces?friendly accreditation encouraged trusts to consider what additional support could be offered to serving personnel, but this was not mandated nationally.

In response to questions, the Panel discussed:

m)   Differences between policy intent and lived experience reported by members of the armed forces community locally;

n)    Ambiguity within published reports referring to the “armed forces community” without clearly distinguishing between veterans and serving personnel;

o)    The need for greater clarity on how  ...  view the full minutes text for item 133.

For the Committee to review the progress of actions.

Members agreed to note the progress of the Action Log.

For the Committee to discuss item on the work programme.

The Panel agreed to add the following items to the work programme:

1.     Community Meals Service

To Consider passing a resolution under Section 100A(2/3/4) of the Local Government Act 1972 to exclude the press and public from the meeting for the following items of business, on the grounds that they involve the likely disclosure of exempt information as defined in paragraph 3 of Part 1 of Schedule 12A of the Act, as amended by the Freedom of Information Act 2000.

There were no items of exempt business.